THE  CARE  AND  FEEDING 


►f  California 

Regional 

Facility 


OF  CHILDRj 


„  EMMETT  MOLT.  M.  D. 


LIBRARY 

THE  UNIVERSITY 

OF  CALIFORNIA 

SANTA  BARBARA 

PRESENTED  BY 

MRS.    ALFRED  W.     I NGALLS 


Digitized  by  tine  Internet  Arciiive 

in  2007  witii  funding  from 

IVIicrosoft  Corporation 


littp://www.arcli  ive.org/details/carefeedingofcliOOIioltiala 


THE  CARE  AND  FEEDING 
OF  CHILDREN^ 

A    CATECHISM    FOR    THE    USE    OF    MOTHERS 
AND    CHILDREN'S    NURSES 


FY 

L.    EMMETT    HOLT,   M.D.,   LL.D. 

!  K'.'I  KSSOK    OF    I-llSEA'-KS    (IF    (HILDRhN    IN    'IH  K    COM.Ef.E    OF    I'H  YSICI ANS 

AND    SLKGEONS    JCOI.IMHIA    INIVERSITV j 

ATTFINDIN'i    IHVSICIAN    'I  O     Mih    KABIES'    HOSPITAL    AND    'UlE 

FOlNLJl.ING    )i<_.-l'l']  A!  ,    NKW    YOKK 


i^ourtb  "CDition,  £lrt^ISl'^  anb  <?nlar[]iEi3 


NEW  YORK   AND   LONDON 

D.    APPLETON    AND    COMPANY 

1907 


CViPYRioriT,  1804,  ISOr,  190:5,  1000 
By  D.   APPLETOX   AND   COMPANY 


TO 
THE   YOUXC    ^[OTIIKIIS   OF  AMKIUCA, 

TOWAKD    THK   SIH.l'TION'    <iF    WHOSE    PROKLEMS 
TUKSK    I'ACiKS    HA\  K    l!Kh:N    I)h:V(lT>:D, 

THIS  Fourth  emtkin 

IS    K  K  s  r  >;  (•  T  K  r  I,  I.  \'     i  >  >:  d  i « ;  a  t  e  D 

KV    JUK    AlTHWK. 


I'KEFACE    TO    THE    EOURT]!    EDITION 


'J'liE  constant  use  of  tlio  ('at(H'hism  as  a  manual 
for  nur.serv  maids  lias  shown  the  need  of  fuller  treat- 
ment of  several  suhjeets  than  was  given  in  the  earlier 
editions.  A  desire  lias  Ikh'Ii  exjn'essed  by  mothers 
and  nurses  outside  of  instituti(»ns  who  have  made 
tIk^  book  a  nursery  liuide,  for  fuller  and  mtire  definite 
iustrnction  in  matters  relating  to  older  children. 

In  the  ])resent  revision,  therefore,  the  })ages  upon 
the  diet  of  children  from  three  to  ten  years  have  been 
entirely  rewritten  and  the  ^ubje(•t  much  exjianded  ; 
while  other  (juestions  relating  to  disturbances  of  di- 
g(-stii)U  at  this  ])ei-iod  are  new  considei'ed  for  the 
tirst  time.  Weight  charts  have  i)een  added,  one  for 
a  weekly  record  for  the  iii-st  yeai-;  the  second  for  a 
>oi)ii-aiiniial  record  t'roiii  th(  tii'st-  t<j  tlie  foui'teentii 
yea  I'. 

'I  he  chapters  upon  infant  feeding  have  b(-en 
ciilai-gcil  and,  it,  is  liop('d,  -inipliticd  foi-  the  avei'ag*', 
reader.  Some  fiii'tlicr  dciail-^  relating  to  intant.s 
wlio>e    niiti'ilion     IS    dilliciilt,    lia\('    lieen     ml  ro(iiice<lj 


6  THE   CARE   AND    FEEDING   OF  CHILDREN 

altliougli  the  scope  of  the  hook  makes  tliis  part  neces- 
sarily brief. 

The  author's  aim  has  been  not  to  ahirm  the  mother 
by  acquainting  lier  with  all  the  possible  diseases  and 
accidents  which  may  befall  her  child,  but  to  open 
her  eyes  to  matters  which  are  her  direct  and  chief 
concern. 

It  is,  therefore,  the  needs  of  the  well  child,  not  tiie 
sick  one,  which  have  been  considered.  The  well  child 
must,  in  most  cases,  lie  left  to  the  care  of  the  mother 
or  nurse  for  whose  guidance  and  assistance  these 
pages  are  intended.  For  directions  in  matters  of  ill- 
ness, however,  no  mother  or  nurse  should  depend  upon 
any  manual,  but  upon  the  advice  of  a  physician. 

It  is  hojied  that  the  mothers  and  nurses  who  have 
found  the  earlier  editions  of  the  Catechism  helpful 
in  the  solution  of  some  of  their  nursery  problems 
will  find  even  greater  assistance  from  the  present 
volume. 

New  York,  1906. 


PREFACE    TO    TILE    FIK^T    EDITIOX 


AVhkx  in  the  fall  of  !>>!•  the  Practical  Trainiiic; 
School  for  Niirserv  ^faid.-  was  opened  in  connection 
with  tlie  Ijahies'  Ilosjjital  of  New  York,  the  need  was 
^oon  felt  for  some  simple  manual  to  j^iit  into  the  hands 
of  the  nurses.  Xone  conld  l)e  found  which  fulfilled 
the  iMNjuirements  of  sim])licity,  hrevitv,  and  exactness 
with  reference  to  matters  of  infant  feeding  and  nurs- 
f-rv  hvoicne. 

A  series  of  questions  was  written  out  hy  the  au- 
thor for  the  ])ur])ose  of  formuh'itinir  for  the  nurses 
undci-  ti-aining  those  thina'~^  whicli  were  mattei's  of 
(hiilv  ohr-('r\ation  in  the  jtractical  work  of  the  IIos])i- 
tah  J'rom  time  to  time  additiojis  lutve  heeii  made  to 
thf-c,  until  the  present  si/e  has  l)een  reache(l. 

'Ihis  ('atechism  is  now,  at  the  re(piest  of  numv 
friends,  pid)lished,  with  the  hope  that  it  may  serve  a 
u-eful  pui'po-e  in  othei'  iu-t  itut  iotis  where  sinnhir 
-(•ho<ds  for  traiinna'  maN'  lie  (-lahh'-h('d.  At  the  same 
lime,  it   is  tiiouaht  that  it    mav  lic  of  value  \i\  many 

7 


THE  CARK  AND  FEEDING  OP  CHILDREN 


mothers  in  the  care  of  tlunr  own  children,  or  a  book 
which  they  may  safely  put  into  the  hands  of  the  ordi- 
nary (untrained)  child's  nurse. 

In  tiu>  {)re])arati()n  of  tliis  Catechism  everything 
has  been  sacriticc^l  to  clearness  and  simplicity.  It 
lias  been  deemed  best  to  emphasize  strongly  the  es- 
sentials, without  going  into  many  minor  details  which 
would  have  increased  materially  the  size  of  the  book 
without  adding  to  its  usefulness.  The  style  of  ques- 
tion and  answer  has  been  adoj)ted  in  order  to  impress 
more  strongly  the  facts  stated. 

March,  18H. 


CONTENTS 


THE   (AKK   OF   CHILDREN 


IJathiiig 

(icnitiil  organs 

Kyps   . 

.Mouth 

Skill    . 

Clothing 

Napkins 

NiirstTV 

Airing 

Weight,  growth,  and  development 

Dentition 


PA  OK 

15 
1(3 
17 
18 
19 
21 
24 
25 
27 
-'50 
;3G 


II 


IXFANF    FI- 


Xiirsiiig       ..... 

Weaning  from  the  breast  . 

Weaning  from  the  bottle  . 

Artifii'ial  feeijing 

Selection  und  <;are  of  milk  u-ed  foi-  infant  teedin; 


FDIN'(; 


42 
49 
52 
54 
54 


10 


THE  CAKE   AND   FEEDING   OF  CHILDREN 


Mddifiration  of  row's  milk 

Top  milk,  68  ;  cream,  ()(!. 
Food  for  lioiilthy  infants,  the  ejirly  niontlis      .         .         .         . 

Formulas  fi'om   lO-per-cent    milk,  70;   formulas  fi-oiu 

T-per-cent  milk,  71. 
Food  for  healthy  infants,  the  later  months      .        .        .        . 

Formulas  from  7-per-cent  milk,  75. 
General  rules  for  {i:uidRnee  in  feeding 

How  to  begiu,  79;  increasing  the  food,  80;  reducing 

the  food,  82. 
Addition  of  other  foods  to  milk         ...... 

Use   of   beef   juice,    86;    white    of    egg,    SG;    orange 

juice,  86. 
Overfeeding        ........... 

Loss  of  appetite 

Changes  in  food  re(piired  by  special  symptoms 

Formulas     from     plain     milk,     90;     vomiting,     91; 

colic,    93 :    constipation,    94 ;    hot   weather,    95 ;    use 

of   condensed  milk,  96;   acute  illness,  98;    diarrluea, 

99. 
Common  mistakes  in  infant  feeding 
Preparation  of  milk  at  liome     . 
Directions  for  feeding       .... 

Intervals  of  feeding 

Schedule  of  quantities  and  intervals  for  first  y 
Kegularity  in  feeding        .... 
Sterilized  milk   ...... 

I'asteurized  milk 

Modified  milk  from  the  milk  laboratories 

Peptonized  milk 

Feeding  during  the  second  year 
Schedule  for  twelith  to  fifteenth  montl;  . 
Schedule  for  fifteenth  to  eighteentli  month 
Schedule  for  eighteenth  to  twenty-fourth  month 
Feeding  during  the  third  year  .... 


PACK 

59 


87 
S9 
90 


100 
102 
105 
107 
108 
109 

no 
]i;5 

114 
115 
118 
119 
V2l 
122 
123 


rOXTKXTS 


11 


III 

THE   DIET   OF   OLDER   CHILDREX 

I'XCitC 

Milk  and  cream ,        .         .         .     127 

Kggs 1-29 

Moats  ami  fish 130 

Vegetables 131 

Cereals 133 

15roths  and  soups 134 

Uread,  crackers,  and  cakes 135 

Desserts 13") 

Fruits l:>7 

Indigestion  in  older  children 13!) 

Acute  indigestion.  140;  chronic  indigestion,  141. 

(ieneral  rules  to  be  observed  in  feeding 143 

Food  formulas   ..........     14G 

I>eef  juice,  146:  mutton  broth,  147;  chicken,  veal,  and 
beef  broths,  148;  meat  pulp,  148;  junket,  curds,  and 
whey,  148:  barley  jelly,  149;  barley  water,  149;  oat, 
wheat,  rice  jelly,  149;  imperial  granum.  150;  albumin 
water,  150  ;  lime  water,  150  ;  dried  bread,  151 ;  coddled 
egg,  151. 


IV 


P.owels 

155 

SIee[i   .... 

157 

('au-fs  of  disturbed  sleep 

159 

Fxercise 

lt)l 

Crv     . 

!»)-3 

Lifting  children 

it;4 

'!'fnip(!rature 

U55 

Xervmisness 

107 

12 


THE   CARE   AND   FEEDING   OP  CHILDREN 


Playing  witli  babies  . 

Toys 

Kissing       .... 

Convulsions 

Foreign  bodies  swallowed 

Foreign  bodies  in  the  ear  . 

Foreign  bodies  in  the  nose 

Colic  . 

Earache 

Croup 

Contagious  diseases 

Measles,  175;  German  measles,  176;  scarlet  fever,  177; 

whooping  cough,  177;   chicken  pox,  177;  diphtheria, 

178:  mumps,  178. 

Treatment  for  commencing  illness 

Nursery  training  to  help  the  doctor 

Scurvy         

Constipation 

Diarrhoea 

Bad  habits 

Vaccination 

Weight  charts 191 


PAGE 
167 

168 
170 
170 
171 
172 
172 
172 
173 
174 
175 


179 

180 
180 
182 
184 
185 
189 
192 


PART   I 
THE    CARE    OF    C'lIILDKEX 


THE    CARE    AXD   FEEDING   OF 
CHILDKEX 


I 

THE   CARE    OF   CIIILDREX 

BATIIIXG 

At  v-hat  age  vkuj  a  cliUd  he  given  a  full  tuh  hath? 
Usually    when    ten    days    old;    it    should   not    be 
i;-i\-en  before  the  cord  has  come  off. 

Ifoir  sJtouId  tJie  hath   he  given? 

It  should  not  be  c'iven  sooner  than  one  hour  after 
fce(lina'.  'i'he  room  should  l)e  warru ;  if  possible 
there  shoidd  be  an  open  fire.  1  he  head  and  face 
>liould  lir>t  be  \va-hed  an<l  dried;  then  tlie  liody 
>hould  be  soaped  and  the  infant  ])laeed  in  the  tub 
with  it-  bddy  well  su])ported  b\"  the  baud  of  th(^ 
nur.-e.  The  bath  shouhl  be  iii\-en  (|iilchly,  aud  the 
bndy  dfiod  rapidly  witli  a  soft  towel,  but  with  vei'V 
little   I'ubbiuir. 

.1/  }rjiiil  If'in firraf iivr  sJioaltJ  llic  halji   hr  (jivm^ 
For   the    lir-t   few   week-   at     100'    F.  :    latci-.   dur- 
iuL""    (-arlv     lufaiicN-,    at     '.'^^     V.:    after    six    months. 


16         THE   CARE   AND   FEEDINCx    OF   CHILDREN 

at    1)5^    F.  ;    iluring    the   second   year,    from    85°    to 
1)0°  F. 

WifJt  v'Jial  should  the  hath  he  given? 

Soft  sponges  are  useful  for  batliing  the  body, 
limbs  and  scalp.  There  should  be  a  se])aratc  wash- 
cloth for  the  face  and  another  for  the  buttocks. 

What  are  the  ohjeclions  io  hath  sponges? 

When  used  frequently,  they  become  very  dirty 
and  are  liable  to  cause  infection  of  the  eyes,  mouth 
or  genital  organs. 

Under  ivliat  circinnstanees  shoidd  the  daily  tub 
bath  bo  omitted? 

In  the  case  of  very  feeble  or  delicate  infants  on 
account  of  the  exposure  and  fatigue,  and  in  all  forms 
of  acute  illness  except  by  direction  of  the  physician. 
In  eczema  and  many  other  forms  of  skin  disease 
much  harm  is  often  done  by  bathing  with  soap  and 
water,  or  even  with  water  alone. 

(JKNITAI.    OKGAIS^S 

IIow  shoidd  the  genital  organs  of  a  female  child 
be  cleansed? 

]>est  with  fresh  absorbent  cotton  and  tepid  water, 
or  a  solution  of  boric  acid,  two  teaspoonfuls  to  the 
pint.  This  should  be  done  carefully  at  least  once  a 
day.     If  any  discharge  is  present,  the  boric-acid  so- 


EYES  17 

lutidii  .^^liould  invariably  Ik  iikmI  iwicc  a  day.  Great 
care  is  necessary  at  all  tinies  to  ])revent  infection 
Avliicli  often  arises  from  soiled  na])kins. 

1 1  oil-  should  the  (j('}tt((d  vnjaiis  of  a  male  clidd 
he   rji'diiscd  .■' 

\n  infancy  and  early  cinldliodd  tlie  foreskin 
should  lie  ])uslie(l  liack  at  least  twice  a  \ve(dv  Avldle 
the  child  is  in  his  hath,  and  the  ]iarts  thus  expesed 
\vaslied  iiently  \vitii  ahsurhent  cdtlon  and   water. 

If  the  foreskin  is  tiiihtly  adherent  and  (.'atmot 
readily  he  ])Ushed  hack,  the  iihysicdan's  attention 
should  he  called  to  it.  The  nurse  or  mother  should 
not   attempt  for<-ihh'  stretchiiii:'. 

W  lit'ti    IX  CI fciiincisKDi   (uJnsahh! 

r>ually,  when  tlie  fni-c^kni  is  \'erv  louu'  and  so 
tiiz'ht  that  it  camiot  he  ]tu>he(l  liack  without  fnrce ; 
alwavs,  when  this  cundilinn  i-  acc(Mu])anie(l  hy  evi- 
dences of  local  irritati'iu  <.'r  (iitijculty  in  jKHssui^ 
water. 


Ihnr  should  /he  ci/ts  nf  a  li':li'  Ixdnf  he  eh  n/iscd ? 

W'ilh  a  |iicce  ot'  -oft  liueu  oi'  ahxirlu'iil  coiton 
and  a  iukewai'm  solution  of  -all  (U-  iioric  acid,- -one 
half  (d'  an  cxcu   tcji-poonf  ii  I   in  one   [uut  <it    water. 


18         THE   CARE   AND    FKKDING    OF   CHILDREN 

//'  j)us  appcdrs  ill  the  cijcs,  ii'liat  shoiihl  he 
(lone  ! 

'X\\c\  should  he  cloansiMl  (n-crv  hour  with  a  sohi- 
tion  of  horic  acid  (ten  i>,rains  to  one  ounce  of  water). 
If  the  lids  stick  toii'ether,  a  little  vaseline  from  a  tnhe 
slionld  he  ruhhed  n])on  them  at  ni^^ht.  If  the  tron])lc 
is  slig-ht,  this  treatment  will  control  it;  if  it  is  severe, 
a  physician  should  he  called  immediately,  as  delay 
may  result  in  loss  of  eyesight. 

]MOUTII 

How  is  an  infani's  vioidJi  io  he  eleansed? 

An  excellent  method  is  hy  the  nse  of  a  swah  ma<le 
by  twisting  a  bit  of  absorbent  cotton  upon  a  wooden 
toothpick.  With  this  the  folds  between  the  gums  and 
lips  and  cheeks  may  he  gently  and  carefully  cleansed 
twice  a  day  nnless  the  mouth  is  sore.  It  is  not  neces- 
sary after  every  feeding.  The  finger  of  the  nurse, 
often  employed,  is  too  large  and  liable  to  injure  the 
delicate  mucous  membrane. 

What  is  sprue:' 

It  appears  on  the  lips  and  inside  the  checks  like 
little  white  threads  or  flakes.  It  is  also  called  thrush. 
In  bad  cases  it  may  coxer  the  tongue  and  the  whole 
of  the  inside  of  the  mouth. 


SKIN  19 

llow  should  a  inoutli  he  clciutscd  irhcn  there  is 
sprue / 

It  sliould  !)('  washed  carefully  after  every  feediiii; 
or  mirsiiio-  with  a  solution  of  horax  or  bicarbonate  of 
-•ida  (baking-  soda),  one  even  teaspoonful  to  three 
"lunces  of  water,  and  four  times  a  (.lay  the  boric-acid 
><dution  mentioned  should  be  used. 

SKTX 

Jloy  should  (he  hifaiil's  skin  he  eared  for  lo 
jinrmt  chaliiKji 

Fii'>t,  not  too  much  nor  too  strong'  soap  should  be 
used;  secondly,  careful  rinsing  of  the  body;  thirdly, 
7iot  too  vigorous  rubbing,  either  during  or  after  the 
bath;  fourthly,  the  use  of  dustiug  ])o\vder  in  all  the 
folds  of  the  skill, — under  the  arms,  behind  the  ears, 
idiout  the  neck,  in  the  groin,  etc.  This  is  of  the. 
utmost  importance  in  very  fat  infants. 

//'  Ihc  sh-'ni  Is  rrrij  scusihrc  (ind  ehnfuiij  rasilij 
jirad need .   irhul  should  he  done.'' 

Xo  so;ip  should  be  used,  but  bi'an  or  salt  l)aths 
given   instead. 

Jhiir  should  n   hrun   hulh    hr  jn(  jxtrrd  / 
( )n<'  pint  r)f  wheat  bi'an  -hnidd  1  <'  pla<'<'d   in  a  l»ag 
(.f  (■<iar>e  mu-lin  or  chee-e-clnt  b.   and    this  put    in   th<' 


20         TIIK   CARE   AND   FP:EDING    OF  CHILDREN 

bath  \vat(M\  It  slioiild  then  ho  squeezed  for  five  min- 
utes, until  the  \vat(>r  resembles  a  thin  porridge. 

llow  s]}ould  a  salt  balh  he  prepared? 

A  tc^acupful  (vf  common  salt  or  sea  salt  should  be 
used  to  each  two  gallons  of  water. 

lloiv  should  the  buttocks  lie  cared  for? 

This  is  the  most  common  place  for  chafing,  as  the 
parts  are  so  fre(piently  wet  and  soiled ;  hence  the 
utmost  pains  should  be  taken  that  all  napkins  be  re- 
moved as  soon  as  they  are  wet  or  soiled,  and  the  parts 
kept  scrupulously  clean. 

If  the  parts  have  hccome  chafed,  what  should  he 
done  ? 

Only  bran  and  salt  baths  should  be  used,  and  in 
very  severe  cases  even  these  may  have  to  be  omitted 
for  a  day  or  two.  The  {)arts  may  be  cleansed  with 
sweet  oil  and  a  little  absorbent  cotton,  and  the  skin 
kept  covered  with  a  dusting  powder  composed  of 
starch  two  parts,  boric  acid  one  part. 

What  is  pricJdy  heal,  and  how  is  it  produced? 

It  consists  of  fine  red  pimples,  and  is  caused  by 
excessive  ]X'rspiration  and  the  irritation  of  flannel 
underclothing. 

How  sliould  it  l)e  treated? 

Muslin  or  linen  shf)uld  be  put  next  to  the  skin; 
the  entire  body  shoubl    1k>   sponged  frequently  with 


eLUTUING  21 


equal  })arts  of  vinegar  and  water,  and  plenty  of  the 
starch  and  boric-aeid  powder  mentioned  should  be 
used. 

CLOTH  IN(; 

W/ial  arc  the  most  rsscnlid]  ihrtujs  in  ilic  clothing 
of  infants^ 

That  the  chest  shall  be  covered  with  soft  flannel, 
tlK'  lind)s  well  protected  but  not  confined,  and  the 
abdomen  sup])orted  bv  a  broad  flannel  band,  which 
should  be  snug-  but  n<tt  ton  tight.  It  is  imj)ortant 
that  the  clothing  should  fit  the  body.  If  it  is  too 
tight  it  interferes  with  tlie  fre(>  movements  of  the 
chest  in  breathing,  and  ])y  pr(-ssing  u])f)n  the  stomach 
sometimes  causes  the  infant  to  v(»mit  soon  after  swal- 
lowing its  foocL  If  the  (dotliing  is  too  loose  it  is 
soon  thrown  into  (h'cp  folds  oi"  bunches,  which  cause 
much  discomfort.  Xo  pins  shoidd  be  used,  but,  in- 
stead, all  bands  about  the  body  should  be  liasfcd. 
The  petticoats  should  \^v  sup])orted  by  shoulder 
straps. 

Jfoir  sjiouhl  llic  tiijdiil  he  lt(l(l  diiniKj  drcsstuij 
and  II nd rcssnKj  ^ 

Xoihing  is  moi'c  awkwai'd  tliau  lo  attempt  to 
di'e->  a  \oung  baby  lu  a  -ittiiig  postinv-.  It  shonhl 
lie    upon    tlie    Ulir-e"s    hiji    iiutil    (|iiit<     oM    eiiongli    to 


22    THE  CAKE  AND  FEEDING  OF  CHILDREN 

sit  iilone,  tlio  clotliiiiii.'  Inking  drawn  over  the  cliild's 
foot,  not  8li}i])0(l  ovor  the  lioad. 

Of  irJiat  use  is  the  hand? 

It  })rotoets  tlio  abdomon,  lint  its  most  imj)ortant 
uso  is  to  su])])ort  tlio  abdoniiind  walls  in  very  youni^ 
infants,  and  in  tliis  way  to  prevent  the  occnrrenco  of 
niptnre. 

llou-  long  Is  iJiis  hand  reqtiiredf 

The  snnp:  flannel  band,  not  nsnally  more  than 
four  months.  In  healthy  infants  this  may  then  be 
replaced  by  the  knitted  band,  which  may  be  worn 
up  to  eighteen  months.  The  band  is  an  important 
article  of  dress  in  the  ease  of  thin  infants  whose  ab- 
dominal organs  are  not  sufficiently  protected  by  fat. 
With  such,  or  with  those  prone  to  diarrhoea,  it  is 
often  advisable  to  continue  the  band  until  the  third 
year. 

WJiaf  changes  are  io  he  inade  in  the  clothing  of 
infants  in  ttie  summer? 

Only  the  thinnest  gauze  flannel  undershirts 
should  be  worn,  and  changes  in  temperature  should 
be  met  by  changes  in  the  outer  garments.  The  great- 
est care  should  he  taktMi  that  children  are  not  ke])t 
too  hot  in  the  middle  of  the  day,  while  extra  wraj)^ 
should  be  used  morning  and  evening,  especially  at 
the  seashore  or  in  the  mountains. 


CLOTilING 


2:J 


Should  older  rliildr(  n  he  alloircd  lo  go  iritli  (licir 
legs  bare  ! 

If  stroiiii'  and  well  tlic'Tc  is  no  dhjcetioii  to  this  in 
\T'rv  hot  wcallicr.  In  cdld  wcatlicr.  howover,  it  is 
<l()nlitfnl  if  any  children  arc  hcn(>fitcd  by  it,  particn- 
hirly  in  a  chan^calih'  climate  like  that  of  Xew  York. 
Many  delicate  children  are  cei'tainly  injnred  by  snch 
attenijits  at  hardeninu'. 

Whai  sorl  of  uiidcfclo/li hig  s/ioiild  he  irorn  dur- 
(ug  cold  trcdtlicrf 

\e\"er  ihe  heaviest  weight,  even  in  winter.  Fonr 
jii-ades  arc  nsnally  sold,  the  next  to  tlie  heaviest  Ixnni; 
thick  enouiih   for  any  child. 

Do  mile  children  reqi(i]'r  as  hcarij  fhinneh  as 
older  jieople  ! 

Xiit  as  a  i-ide.  They  nsnally  liv(^  in  a  warm 
niir>ery;  their  circulation  is  active;  and  they  always 
Iier<])ii'e  easily  diirinti'  their  ])hiy.  When  they  li'o  out 
of  do<ii-s,  the  addition  of  coats  and  leii'iiiiiii's  I'cnders 
thick  tiannels  unnecessary. 

.\re  itol  iionii/  III  lie  children  clot  lied  loo  Ihinli/ 
jor  Hie  ordinari/  house  f 

\'erv  few.  The  almost  in\'ariable  luistake  made 
in  city  homes  is  that  <d"  excessive  (dothinii"  and  too 
wai'iii  I'oduis.  'riie>e  two  thini;<  are  amonu"  the  Tuost 
fi'eiiuent    I'casons   for  their  takiiii:'  cold  so  easilv. 


24         THE   ("ARE   AND    FEEDING    OK   CHILDREN 


.NAl'KIXS 

lloir  shouhj  iKipkith-^  he  Inken  care  of? 

Hiev  slioiild  he  iiimuMliatolv  removed  from  the 
nursorv  when  soiled  or  wet.  Soiled  napkins  should 
he  kept  in  a  reeeptach^  with  a  tiirht  cover,  and  washed 
as  soon  as  jwssihle. 

Should  ■napkins  irliirJi  have  been  onhj  wet  he 
used  a  second  innc  icdhout  washing! 

It  is  no  douht  better  to  use  only  fresh  napkins, 
hut  there  is  no  serious  objection  to  using  them  twice 
nnless  there  is  chafing  of  the  skin.  Clean  napkins, 
changed  as  soon  as  wer  or  soiled,  are  of  much  im- 
portance in  keeping  the  skin  healthy. 

What  are  tJie  important  things  to  he  ohserved  in 
washing  napkins? 

Soiled  napkins  should  not  be  allowed  to  dry,  but 
should  receive  a  rough  washing  at  once;  they  should 
then  be  kept  in  soak  in  ])laiii  water  until  a  conven- 
ient time  for  washing, — at  kvist  once  every  day. — 
when  they  should  b(^  waslu^l  in  hot  suds  and  boiled 
at  least  fifteen  minutes.  Afterward  they  should  be 
very  thoroughly  rinsed  or  they  may  irritate  the  skin, 
and  ironed  without  starch  or  blueing.  They  should 
never  be  used  when  <lamp. 


xrusERV 


XriiSKKY 


Wild  I  (t/c  the  esscnfinJs  in   a  good  nursery? 

The  funiisliiiigs  should  be  vcrv  siuijilc.  ami  uii- 
Ticcessarv  liaiigiuiis  and  upholstered  funiiture  should 
be  excluded.  As  large  a  room  as  ])(>ssil)le  shoidd  he 
s<'leetcd — due  that  is  ^vell  ventilated,  and  always  one 
in  which  the  sun  shines  at  some  ])art  of  the  dav.  as 
it  sliMuld  Ik-  remendx'red  that  an  av(M-a£re  child  sjicnds 
here  at  least  three  fourths  of  it?  time  durinii'  the  first 
year.  The  nurserv  should  have  dark  shades  at  the 
wind(i\\s,  hut  no  extra  hanainu's  or  curtains;  al)out 
the  hahy's  ci'ih  nothinu'  huT  vhar  can  he  wash('(l 
shoidd  he  allowed.  The  air  should  he  kept  as  fresh 
and  a>  pure  as  ])ossihle.  Thei'e  should  he  no  ])lumh- 
inu\  no  dryinfr  of  najikins  or  clothes,  no  cookina'  '>f 
food,  and  no  gas  btirniiiir  at  niiiht.  A  small  wax 
niglitdight  answers  every  ])urj)ose. 

flow  sJioidd  a  rnirscn/  Ijp  lienlcd ? 

\'>o<\  \)\  an  o])en  fire;  next  to  this  hy  a  Franklin 
-tove.  'i'he  ordinary  hot-air  furnace  of  cities  has 
mativ  oh)eclions,  l)ut  it  is  not  so  had  as  steam  heat 
from  a  I'adiator  in  the  room.  A  i:a^  -io\-e  i<  even 
woi-se  than  this,  and  should  never  he  ii-e(|.  except, 
perhaps,  tor  a  few  minutes  <luriiii:  th<-  uioi'iiiiiu' 
halh. 


■20         TIIK   CAKH   AND    FKKDING   OP   CIIILDUKN 

.1/  ichal  fcnipcrdfurr  sJioiihl  a  nin-scrif  he  kept 
(hiriinj  fill-  (1(11/. ■* 

J5os(,  (U)'^  to  <)>i^  l'\,  ineasnrcd  l)_v  a  tluMMiioiuoter 
liaiiiiiiiii'  tlircc  feet  from  tlio  floor.  Xover  should  t]H3 
toin])eratur(^  he  allowcMl  to  go  above  70^  F. 

.1/  trJiat  fonpcralnrc  (hiring  Ihc  n'ujlit? 

Duriilii-  the  first  two  or  three  months,  not  l)ehnv 
(ir>°  Y.  After  threc^  niontlis  the  temperature  nvAX  go 
as  low  as  ."),">-'  ¥ .  After  the  first  year  it  may  1x3  50^ 
or  even  45~^  F. 

At  ivhni  a(j(>  may  the  window  he  left  open  at 
n  igh  t  ? 

Usually  after  the  third  month,  except  when  the 
outside  teni])erature  is  helow  freezing  point. 

How  often  should  the  nursery  he  aired? 

At  least  twice  a  day — in  the  morning  after  the 
child's  bath,  and  again  in  the  evening  before  the 
child  is  ])Ut  to  bed  for  the  night.  This  should  be 
done  tlioroughly,  and  the  child  should  be  removed 
meanwhile  to  another  a])artment.  It  is  well  to  air 
the  nursery  whenever  the  child  is  out  of  the  room. 

What  symptoms  are  seen  in  a  child  who  is  kept 
in  too  hot  a  room  / 

It  becomes  ]iale,  loses  appetite,  shows  symptoms 
of  indigestion,  occasionally  vomits,  stops  gaining  in 


AIKIXG  27 

weiglit,  ]H'rs])ires  very  nnicli,  and  takes  cdld  easily 
l)eeanse  of  this  and  also  because  of  the  <:reat  diiftM'- 
ence  })et\veen  The  indoor  and  outdoor  temperatures. 
Its  condition  may  be  such  as  to  lead  one  to  suspect 
\-erv  serious  illness. 


AIRING 

llou-  carhj  may  airing  indoors  he  conunmrcd  and 
liotr  loiK]  nunj  it  he  continued? 

Airinu'  in  the  room  may  be  begun,  even  in  cold 
weather,  wheii  the  child  is  (uie  UKiuth  old,  at  first  for 
only  fifteen  minutes  at  a  time.  This  ])eriod  may  ])(' 
gradually  lena'thened  by  ten  or  fifteen  minutes  each 
(hty  until  it  is  four  or  five  hours.  'I'his  airiuii'  nuiy 
Im-  contiiuied  in  alm<»st  all  kinds  of  weather. 

Is  there  not  f/reat  danger  of  a  young  hahij's  talc- 
ing cold  irhen  aired  in  this  nuninerf 

Not  it"  the  ])erio(l  is  at  first  short  and  the  baby 
accustome<!  to  it  i;i'adually.  lnste;id  of  ren<lerini;'  the 
child  liable  to  take  cold,  it  is  the  best  means  (.>f  pre- 
vent inir  <-olds. 

I  loir  should  siudi  an  airing  he  (jireu.' 
'i'he  child  should  be  (li-esse(l  with  bonnet  and  liu'ht 
coat  as  if  fof  the  street   and  phieed   in   it-  crib  or  eai-- 
I'iaj^c    which    shoidd   stand    a    few  fe<>t   from    the   win- 
dow.      All    \]h-    wifidows    ai'c    then    thrown    wide    open. 


28         TllK    CAKK   AND    FEKDINC;    UF   CHILDKKN 


hut  the   (looi-s  cIosimI    to  ]»r('V('nt  dranylits.      Screens 
are  uiincccssarv. 

.1/  }rhai  a<jc  mnji  a  child  go  out  of  doors? 

In  sniiiiiier,  wlien  one  Aveek  old;  in  sprinjjj  and 
fall,  usually  at  al)out  one  month;  in  winter,  when 
ahout  tliree  UKinihs  ohl,  on  ]ileasant  days,  l)einu;  kept 
in  the  sun  and  out  of  the  wind. 

What  are  the  best  liours  for  airing  oUt  of  doors? 

Ill  sunnner  and  early  autumn  a  child  may  he  ont 
almost  any  time  l)etween  seven  in  the  iriorning  and 
sunset ;  in  winter  and  early  sprino;,  a  youn<»;  child 
only  Ix^tween  10  or  11  a.  :\r,  and  3  r.  M.,  althongh 
this  depends  somewhat  upon  the  climate.  Tn  Xew 
York  and  along  the  Atlantic  coast  the  early  morn- 
ings are  a]>t  to  Imj  damp  and  the  afternoons  raw  and 
cloudy. 

O71  irhat  hind  of  days  sJioidd  a  haljy  not  go  out? 

In  sharp  winds,  when  the  gronnd  is  covere<l  with 
melting  snow,  and  when  it  is  extremely  cold.  A  child 
nnder  four  months  old  shonld  not  nsually  go  out  if 
the  thermouieter  is  helow  freezing  point;  nor  one 
under  eight  moutlis  old  if  it  is  below  20^  F. 

WJtat  arc  the  most  import njit  tilings  to  he  attended 
to  when  the  cliild  is  ont  in  its  carriage? 

To  see  that  the  wind  never  hlows  in  its  face,  that 
its  feet  are  })ro])erly  covered  and  warui,  and  that  the 


A I  KING  29 

sun  is  iiovor  allowed   to  .sliiiie  dirocrlv    into  its  eyes 
when  tlie  child  is  either  ask^'p  or  awake. 

Of  ir/idf  advanfiKjc  io  ihc  child  is  (joiiuj  out! 

Fresh  air  is  re(]uired  to  renew  and  ])nrifv  the 
hlood.  and  this  is  jnst  as  neeessarv  for  health  and 
growth  as  j)roper  food. 

Wliiit  arc  flic  effects  produced  i)i  infrnds  hy  frcsJi 
air.' 

I" he  a{i])etite  is  itn])roved,  the  diizestion  is  better, 
the  cheeks  become  red,  and  all  sigirs  of  health  are 
seen. 

Ts  there  anj/  adraidac/e  in  liarin<i  (i  child  take 
its  airitKj  during  flic  first  five  or  six  mouths  in  tlie 
h  ursc  s  (I  tins  ! 

Xonc  whatever.  A  child  can  be  niade  much  mon^ 
comfortable  in  a  bab\'  carriai:"(\  and  can  be  e(|uall_v 
w(dl  protected  against  ex])osnre  by  blaid<ets  and  the 
cari'iage   umbrella. 

II  hat  arc  the  ol^ject ions  to  an  infant's  sIccjiduj 
out  II f  doors ! 

There  ai'e  no  real  objection-.  it  is  not  tiMie  that 
infants  take  coM  moi-e  easily  when  a-lee|i  than  awake, 
while  it  i-  abnost  inva riabi \-  the  ca^e  that  thu^e  wdio 
sl''cp  (lut  oj'  (|(ior>  ni'f  -t  runiifi'  childi'di  an<l  le--  prone 
to  take  cold   than   otiici'-. 


30         THE   CARE   AND   FEEDING   OF   CHILDREN 

Wlial  can  he  done  for  children  wlio  take  cold 
upon  I  he  sli(jhl('sl  provocation? 

Tliev  sliould  1)0  ko))t  in  cool  rooms,  especially 
^vllcn  asle(»]).  'riiev  slionld  not  wear  sncli  heavy 
clotliing'  tliat  they  are  in  a  ])erspiration  much  of 
the  time.  Every  mornino-  the  body,  particularly  the 
chest  and  hack,  should  he  sponged  with  cold  water 
(50°  to  00°  F.). 

How  shordd  tills  cold  sponge  hath  he  given? 

Tlie  cliihl  sliould  stand  in  a  tub  containing  a 
little  warm  wat(>r.  and  a  large  bath  sponge  filled  with 
cold  water  should  l)e  sqneezed  two  or  three  times 
over  the  ])ody.  This  should  be  followed  by  a  vigor- 
ous rubl)ing  with  a  towel  until  the  skin  is  quite  red. 
This  may  be  used  at  three  years,  and  often  at  two 
years.  For  infants  a  little  higher  temperature  (65° 
to  70°)  may  be  used. 

WEIGHT,    GROWTH,    AND    DEVELOPMEXT 

Of  ivhat  importance  Is  the  iveight  of  the  child? 

Xothing  else  tells  so  accurately  how  well  it  is 
thriving. 

During  the  first  year  a  record  of  the  weight  is 
almost  indispensable;  throughout  childhood  it  is  of 
much  interest  and  is  the  best  gnide  to  the  physical 


WEIGHT,    GROWTH,   AXD   DEVELOPMENT  .31 


eonditioii.      It  will  wo]]  ropav  any  morlior  or  nurse 
to  keo})  such  a  record. 

l/oir  frccjiu'iinn  should  a  child  he   vp'Kjhed? 

Kverv  week  durina'  tlie  first  six  luontlis,  and  at 
least  once  in  two  weeks  durinc;  tlie  last  six  months 
of  tIk^  first  year,  l^urino-  the  second  year  a  child 
sh(Mild  he  weighed  at  least  once  a  month. 

How  rapidly  slioiild  an  infant  gain  in  iveight 
during  llic  first  year? 

'idiere  is  usually  a  loss  durinp;  the  first  week  of 
from  four  to  eifflit  ounces;  after  this  a  healthy  cliild 
sliould  cfain  from  four  to  ei^ht  ounces  a  week  up  to 
about  the  sixth  month.  From  six  to  twelve  months 
the  a'ain  is  less,  usually  from  two  to  four  ounces  a 
A\'eek. 

Is  it  to  lie  expected,  that  hottle-fed  infants  will 
gam  as  rapidly  as  those  ivlio  are  nursed? 

'I'hey  seldom  do  so  duriuif  the  first  month;  aft(;r 
that  time  under  favourahle  circumstances  the  g'ain 
i>  usually  (piite  as  r<\a-iilai\  and  duriua  the  latter 
halt  of  the  first  year  it  is  likely  to  he  uiore  con- 
tinuous than  in  a  nursiua'  iufanl.  hecause  the  latter 
n-ually  lox-s  weiii'ht  at   the  time  of  wcaniuir. 

U ////  do  they  not  r/ain  so  raj)idli/  at  /irst.'' 
\i    take-   a   few  weeks   foi-  the   stomadi    to   hccome 
ai'<Mistotried    to   cow's   milk,    and    until    this    is   accom- 


32    THK  CAKK  AND  FEEDING  OF  CHILDREN 


plished  it  is  iicccssarv  to  iiiako  tlie  milk  very  weak 
or  the  eliild's  (liiiX'stioii  will  be  upset. 

For  a  chilli  of  arcrafjc  irelght  at  hirih  (seven 
io  seven  tuul  a  half  pounds)  icliat  sliouhi  he  the 
ivel(/lif  at  the  dljfevetit  periods  dnvlncj  tlie  jirst 
year! 

At  three  iiioiiths  it  slioiild  be  twelve  to  thirteen 
pounds;  at  six  mouths,  tifteen  to  sixteen  pounds;  at 
nine  months,  seventeen  to  eighteen  pounds ;  at  one 
year,  twenty  to  twenty-two  pounds.  At  live  months 
a  healthy  ehild  will  usually  double  its  weight,  and 
at  twelve  uionths  it  will  nearly  treble  its  weight. 

Do  all  healihij  infants  gain  steadily  in  ivelglit 
during  the  first  year? 

As  a  rule  they  do ;  yet  it  is  seldom  the  case  that 
one  gains  every  week  for  the  entire  year.  With  most 
infants  there  are  from  time  to  time  periods  of  a  few 
weeks  in  which  no  gain  is  made.  These  are  more 
often  seen  froui  the  seventh  to  the  tenth  month  and 
frequently  occur  when  the  child  is  cutting  teeth, 
sometimes  during  very  hot  weather. 

Is  It  true  tliat  every  infant  ivlio  gains  rapidly  in 
weight  is  tliriving  normally? 

Xot  invariably.  Some  who  are  fed  upon  pre- 
pared  infant  foods   increase   rapidly  in  weight  but 


WEIGHT,    GROWTH,   AND    DEVELOPMENT  33 

not  in   strciiutli.  lun-   in   their   developnicut  in  other 
res])ects. 

Is  ihe  wchjlii  of  as  tmicli  raluc  in  ilte  second  year 
OS  (I  guide  to  the  child's  condition  .' 

After  the  first  year,  the  txam  In  weight  is  se](h)iii 
eontinnons;  then-  are  nianv  interru])tions,  some  (h'- 
])en(I  on  season,  and  others  often  oecur  withont  a}»- 
])arent  eaiise. 

At  irJtal  (Kje  should  the  fontuncl  rlo.se? 

Tlie  average  i>  ahont  eiirhteen  months.  It  seldom 
(do.-^es  eaidier  tlian  for.rteen  nmnths,  and  it  sliouhl 
nut  he  open  at  two  years. 

Af  irlint  (i(/e  should  a  child  It  old  up  its  It  cad? 

As  a  rule  diirin<:'  th(-  fourth  month,  and  often 
durinL^  the  third  month,  tlie  head  can  Ix'  hehl  erect 
when  the  liody   is  su]ipoi-te(l. 

When  docs  an   infant  first  tatujlt   aloud ! 
rsiially  from   tlie  third   to  the   tifth    luontli. 

When  dors  it  lieijin  to  reach  for  tot/s  and  handle 

titrntf 

Tsually  froiu  the  tifth  to  the  seventh  month. 

At  tritat  uf/c  sitoutd  a  cliitd  lie  aide  to  sit  anil 
It)  sia ltd  alone  / 

At   .-e\-en  nr  ciaht,  iiMmth-  a   hcalthv  child   is  usu- 


34         THE   CARE   AND    FEEDING    OF   ClllLDKEJS 


;illv  ;il>le  to  sit  ei-(H't  and  suj)p()rt  tlie  body.  During 
the  ninth  and  tenth  months  are  usually  scx^n  the  lirst 
att(>ni])ts  to  hear  tli(>  \v(M<:ht  upon  the  fe(^t,  and  at 
(deven  or  twelve  months  most  children  can  stand  with 
assistance. 

^y]l('n  ftJioiild  a  cJiihl  vail,-  alone? 

Tlie  first  attem])ts  are  generally  seen  in  the 
twelfth  or  thirteenth  montli.  At  fifteen  or  sixteen 
months  the  average  child  is  able  to  run  alone. 

Wliat  coiidi lions  poslpone  ihese  events? 

Prematurity,  a  very  delicate  constitution,  any 
severe  or  jirolong-ed  illness,  and  especially  chronic 
disturbances  of  digestion  making  feeding  difficult. 
A  common  cause  of  late  sitting,  standing,  or  walk- 
ing  is  rickets. 

SliouJd  a  rltild  he  lo-f/ed  io  walk? 

Xever ;  he  is  usually  quite  willing  to  do  so  as 
soon  as  his  muscles  and  bones  are  strong  enough. 
Xone  of  the  contrivances  for  teaching  children  to 
walk  are  to  be  advised. 

Vtlien  do  cliUdren  hcijin  io  ialk? 
Generally   at  one   year   a  child   can   say   ''  ])aj)a  "' 
and  ■'  mannna  ''  or  othei'  single  words.      At  the  cud 
of  the  second  year  the  average  child   is  able  to  put 
words  toaether  in  short  sentences. 


WEIGHT.    GROWTH,   AND    DKVELOPMHNT  35 

//  nf  hro  i/rars  the  child  nidhrs  hd  al tempt  to 
.■^pcak,  irlidt  sliDidd  Ijc  snsjicdcd ^ 

Kirlier  tliar  the  cliild  is  a  (Icat'-minc  nv  rliar  it  is 
iiicnrally  (Icliciciit.  altliouiili  this  is  (iccasioiuillv  seen 
ill  cliililfcn   wliii  arc  only  \vv\  liackward. 

Tdble   slioiriiifj    the   Average   Weifflif.  Height,  (iiid    Cir- 
rumference  nf  Head  (lud   (Jtiest  of  Boijs^ 

At  birtli Weifrht 7A  i)ouii(l.s. 

Heiglit -JOA  iiiclies. 

V\\Q<\ V.\l       •' 

Head 14 

<  *iH>  y(,'ar Weiglit 21  pounds. 

Hei.irlit 29    iiiciifs. 

Ciicst IS 

Head 18 

Two  years.  .  .  .Wei<^ht 2G^  pounds. 

ilei.udil o2i  inches. 

Cliest 1!) 

Head 1!) 

Tim-c  years.  ..Wei^dit :)1     pounds. 

Hei;,dit .'5.")     ini-lies. 

Chest 20 

Head lili:       •• 

Four  yeai-s  .  .  .  \Veii,dit li")     pounds. 

I[e-i>,dit :!8    inches. 

Chest 2()y       " 

llea.l \n       •• 

'  \\'ei;,dils  for  the  first   foui-  years  an-  without  elothrs. 

'i"hr  \veii,dit  of  ^nrls  is  on  the  axcra^t-  aliout  one  j)ound  less 
than  hovs.      'I'hey  arc  aljoiil   the  same  in  licii,dit. 

Charts  sliowin^-  wei;.dit  curve  for  tlic  first  year,  and  from  one 
year  to  foui'teen  vears  are  i,Mven  at  lie  end  of  this  hook. 


80         THE   CAKE    AND    EEEDINC    OF   CllILDUEX 


Five  years. . . .  Wei_i::lit 41     pounds. 

Ileiglil 4H  inches. 

Cliest 2U      •• 

Head 20^      " 

Six  years Weight 45    pounds. 

Height 44    inches. 

Chest 23 

Seven  years.  .  .Weiglil 49i  pounds. 

Height 40    inches. 

Chest 2:]h      •' 

Eight  years . .  .Weight 54 i  pounds. 

Height 48    inches. 

Chest 24^      '• 

Xine  years. . .  .Weight 60    pounds. 

Height 50    inches. 

Chest 25 

Ten  years Weight 66|  pounds. 

Height 52    inches. 

Chest 26 

The  above  weights  are  wirh  ordinary  liouse  clothes. 
DEXTITTOX 

IIow  many  ieetli  are  there  in  the  first  set? 
Twenty. 

What  is  lite  time  of  their  appearance? 

The  two  central  lower  teeth  are  nstially  the  first 
to  appear,  and  come  from  the  fifth  to  the  ninth 
month;  next  are  the  fonr  tipper  central  teeth,  wliich 
come  from  tlic  eiu'lirli  to  tlu^  twelfth  month.  The 
other  two  lower  central  teetli  and  the  fonr  front 
double  teeth  come  from  the  twelfth  to  the  eighteenth 
month.      Then  follow  the  fV)iir  canine  teeth,  the  two 


DENTITION  37 


ujtper  ones  beiiiir  kiKnvii  ;i>  tlic  "  vyc  teeth,"  aiul  the 
two  lower  as  the  "  stoinaeh  teeth  "  ;  thev  i2;enevally 
come  hetween  the  eiirhteenth  aiul  the  twenty-fourth 
niontli.  7  he  four  back  double  teeth,  which  complete 
the  first  set.  come  between  the  twenty-fourth  and 
thirtieth  month. 

At  one  year  a  child  nsually  has  six  teeth. 

At  one  and  a  half  years,  twelve  teeth. 

At  two  years,  sixteen  teeth. 

At  two  and  a  half  years,  twenty  teeth. 

WJtaf  are  the  causes  of  variation? 

The  time  of  a])})earance  of  the  teeth  varies  in 
ditferent  families;  in  some  they  come  very  early, 
in  others  much  later.  The  teeth  may  come  late  as 
a  result  of  prolonire<l  illnos  and  also  from  rickets. 

W'ltat  syuipioms  are  coin  manly  seen  witli  teeth- 
ing? 

In  healthy  children  there  is  very  often  fretful- 
ness  aTid  ])oor  sleej)  for  two  or  three  niii'hts ;  there 
may  be  loss  ui  ap])etite,  so  that  only  one  half  the 
n>ual  amount  of  foo<|  is  taken;  there  is  salivation 
or  droo]inL^  and  often  sliii'lit  fevei' ;  there  nuiv  bo 
some  sym]itr»ms  of  indii^estiou.  siicli  as  vouiitiuii'  or 
the  a]i]i<'arancc  of  undlac-ted  fnod  iu  the  stool-;.  In 
d<-lii-;itc  children  all  tli(--e  -ymptoms  may  be  nnudi 
tiion-  -e\-ct'e. 


38         TIIK   CAKK   AND    FKHDING    OK   ('IIILI)UEN 

lloir  hmg  do  IJicse  symptoms  last? 
Usually  oulv  three  or  four  (lavs;  but  there  may 
be  no  gain  in  ^veight  for  two  or  three  weeks. 

WJiaf  is  the  cause  of  most  of  the  other  symptoms 
attributed  to  teething? 

Xearlv  all  of  them  eome  fr(Mii  iiuligestion  due  to 
))acl  feeding. 


PAirr  II 

IX  FA XT     FKKDIXG 


II 

INFANT    FEEDING 

^y]^at  /,?  Otc  hcsf  infatif  food? 
]\rotlicrV  milk. 

Of  irJtaf   is  mother's  milJc  composed? 
Tliirtccii     jiarts     solids     and    eighty-seven    parts 
water. 

Ml  Kit  (irr  the  solids? 

Fat.  sui!a)\  ])roTeids,  and  salts. 

What  is  thr  fat? 
'Ihc  crcaiii. 

]Vhiit  IS  the  siKjar ? 

Ir  is  lact<ise.  (ii-  milk  sugar. 

11  hut  (ire  the  })r()t<'i  Is ? 
'I'hc  curd  (if  the   milk. 

A  rr  (ill  these  eletnents  necessary? 
Ves  :  we  caiiiiot   cxjit'ct    to  rear  a  healthy  infant 
ludcss  llicy  are  all   in  liis  food. 

()f  irhat   ase   is  ilie  fat  ' 

It    is    Tueded    foi-    the    ^i-owtli    of    the    hones,    the 

■11 


42         THE   t"AKE   AND   FEEDING   OF   ClIli.DJiEN" 


nerves,  the  fat  of  the  body,  and  the  production  of 
heat. 

Of  what  use  is  tJie  sugar? 

It  is  needed  for  tlic  production  of  heat,  and  to 
nud^e  fat  in  the  body. 

Of  what  vse  are  the  proteids? 

They  are  needed  for  the  grov/tli  of  the  cells  of  the 
body,  such  as  those  of  the  blood,  the  various  organs, 
and  the  muscles. 

Of  tvhat  use  are  the  sails? 

Particularly  for  the  growth  of  bone. 

Of  what  use  is  the  water? 

By  means  of  the  water  the  food  is  kept  in  a  state 
of  minute  subdivision  or  in  solution,  so  that  the 
delicate  organs  of  a  young  infant  can  digest  it.  It 
is  also  necessary  to  enable  the  body  to  get  rid  of  its 
waste. 

NURSING 

Should  all  mothers  attempt  to  nurse  their  chil- 
dren? 

As  a  rule  they  should  do  so,  but  there  are  many 
conditions  wdien  they  should  not. 

What  are  the  most  important  ones? 

If  the  mother  has  or  has  had  tuberculosis  or  any 
other  serious  chronic  disease,  or  is  herself  in  very 
delicate  health,  she  should  not  try.     She  is  likely  soon 


NURSING 


43 


to  fail  ill  nourishing-  her  child,  and  the  attempt  may 
do  herself  nnich  harm  as  \vell  as  injure  the  child. 

lloir  often  sliould  infants  l>r  nursed  during  the 
first  tiro  (J/ii/s  of  tife? 

1  siiallv  (m]y  four  or  five  times  daily,  since  there 
is  very  little  milk  secreted  at  this  time. 

]\  Ju/i  does  tlie  milk  eome  in  a})undance? 

I  siuilly  (111  the  third  <lay,  sometimes  not  until 
the  fourth  or  fifth  day. 

Should  the  infant  he  fed  ani/fhing  additional 
during  tlie  first  tiro  days? 

Usually  not;  if  much  food  Avere  necessary,  wo 
may  he  sure  Nature  would  have  provided  it.  Water, 
however,  should   he  given  regularly. 

J/oir  frecjuentli/  should  an  infant  he  iiursed  dur- 
iiKj  the  first   veck? 

After  the  third  day,  every  two  hours  during  the 
day  and  twice  during  the  night.  The  fre(iuency 
during  the  rest  of  the  first  year  is  given  in  the  fol- 
lowitii;'  tahle  : 


\<\  aiul  2(1  (lav ;  4 

;{  (lays  to  ()  W("-fks |  10 

(5  weeks  t<i  .'»  nioiit  lis.  S 

.">  I  (J  n  iiiont  lis 7 

5  til  12  ludiil  li^ () 


XursiriKS  in     7,,,,.^..,.,  ,,.,  ,,„..         Night  iiiii-Kiiit,'s 

1 


n  iioui's. 

2       '■ 


44  THE   CAKK   AND    FEKDlXii    OF   CHILDUKX 

Jlow  Jong  should  tlie  diild  he  kepi  al  the  breast 
for  one  n-ursing? 

Xot  over  twenty  minutes. 

Should  the  child  tahe  both  breasts  at  one  nursing? 
If  the  milk  is  very  abundant  one  breast  may  be 
sufficient,  otherwise  both  breasts  may  be  taken. 

^yhat  are  the  important  livings  to  he  attended  to 
in  nursing? 

First,  regularity;  it  is  just  as  important  as  in 
the  case  of  bottle-feeding.  Secondly,  the  nipples 
should  be  kejjt  clean  by  being  washed  after  every 
nursing. 

yVliat  should  be  the  diet  of  a  nursing  mother? 

She  should  have  a  simple  but  generous  diet  with 
plenty  of  fluids ;  three  regular  meals  may  be  given, 
and  gruel,  milk,  or  cocoa  at  bed-time  and  sometimes 
between  meals.  She  may  take  eggs,  cereals,  most 
soups,  and  nearly  all  vegetables,  avoiding  sour  fruits, 
salads,  pastry,  and  most  desserts.  Meat  should  not 
be  taken  more  than  twice  daily,  and  in  many  cases 
but  once.  She  should  take  but  little  tea  or  coffee, 
and  ordinarily  no  wine  or  beer. 

Are  fruits  likely  to  disturb  a  nursing  infant? 
Sour  fruits  in  some  cases  may  do  so,  but  sweet 
fruits  and  most  cooked  fruits  are  useful. 


NUKSING  45 

W'lidf  rise  is  intporlanl  in  the  life  of  the  nursiiuj 
motlicr .'' 

Sli('  slidiild  lead  a  simple  natural  life;  should 
have  rei!iilar  out-of-door  exercise,  ])referal)ly  walkiiii^ 
oi-  (lri\iii<z',  as  soon  after  her  eontineuient  as  her  con- 
dition will  ])erniit.  She  shonld  luive  retrular  move- 
ments from  the  bowels  daily.  She  should  he  as  fre(^ 
as  ])f)ssihle  from  unnecessary  cares  and  worry ;  her 
rest  at  niirht  shoidd  he  distnr])ed  as  little  as  possible: 
she  shonld  lie  down  for  at  least  one  honr  in  the  mid- 
dle of  the  day. 

' Doc-'^.tlic  nervous  condition   of  tJie  moOier  affect 
t/ir  mitk? 

\v\-y  much  more  than  her  diet;  worry,  anxiety, 
fatiii'ue.  loss  of  sleep,  household  car(^s,  social  dissipa- 
tion, etc.,  have  more  than  anythin<i'  else  to  do  with 
tlic  faihire  of  the  luodern  mother  as  a  nnrse.  T^ncon- 
t  rolled  emotions,  <:'ri(>f,  exciteuient,  friii'ht,  passion, 
may  cause  milk  to  disaiiree  with  the  child;  at  times 
tlicy  may  excite  acute  illness,  aiul  ;it  other  times  they 
may  •■au'^e  a  sudden  aud  complete  disa])])earance  of 
iIk'  milk. 

I)(iis  nil  Its! nial  10)1  affect  tlie   iniJh:' 

In  nearly  all  eases  the  (piatitity  of  milk  is  le--;- 
eiiiMl  :-!,  ilijit  tlie  iut'aur  i-  tint  <atistied  ;iiid  ma\'  u'aiu 
le-^  in   wf-iij-jii  oi-  nut  at   all.      In   many  eases  the  ipial- 


4()  THK    CAHK    AND    FEKDINU    OF   (illLDItKX 


itv  of  t\w  milk  is  also  atlV'Ctcd  to  such  a  dogTco  as  to 
cause  slight  (listnrhaiiccs  of  diiix^stiou,  such  as  rcst- 
Icssucss,  colic,  and  ])(M'ha])s  sonic  (hu'anii'cuicnt  of  the 
bowels.  In  a  few,  attacks  of  acute  indiii-estloii  are 
excited. 

Is  regular  Dicnslrua/lon  a  reason  fur  slopping 
nursing  ' 

Not  invariahlv :  as  a  rule  both  functions  do  not 
i2,o  on  together.  But  if  the  child  is  gaininir  reg'u- 
larly  in  weight  betw(>en  the  periods,  nursing  nuiy  be 
continued  indefinitelv,  although  it  may  be  well  to 
feed  the  infant  wholly  or  in  part  during  the  first  day 
or  two  that  the  mother  is  unwell. 

^yhat  sympionis  indicate  tliat  a  nursing  infant  is 
u'ctt  nourished? 

The  child  has  a  good  eoloin-,  sleeps  for  two  or 
tlirec  hours  after  nursing,  or,  if  awake,  is  quiet, 
good-natured,  and  apparently  comfortable.  It  has 
normal  movements  of  the  bowels  and  gains  steadily 
in  weight. 

WJiat  symptoms  indicate  that  a  chitd  vdto  is 
nursing  is  not  properly  nourished  ■ 

It  does  not  gain  and  may  even  lose  in  weight. 
It  no  longer  exhibits  its  usual  energy  and  playful- 
ness, but  is  either  listless  and  indifferent  or  cross, 
fretful  and  irritable,  and  is  apt  to  sleep  poorly.     It 


XUKSIXG  47 

grows  ]»a]c  and  aiiu'ini;-  and  its  tissnes  become  soft 
and  ilaliby.  When  the  milk  is  seantv  it  will  often 
nurse  a  lona'  time  at  the  breasts,  sometimes  three 
(juarters  of  an  hour,  Ind'ore  sto])])inii-.  At  other  times 
it  may  take  tlie  breast  for  a  moment  only,  and  then 
turn  away  in  ajtparent  disiiust. 

ir//c;/  should  he  done  vlicii  sucJi  f^ywptotns  ap- 
jirar  / 

This  de]iends  npon  the  sevei'ity  of  the  symptoms 
and  how  loni:-  tliey  have  lasted.  ]f  the  child  has 
nuide  no  gain  for  three  or  four  weeks,  or  is  losing 
weight,  immeiliate  weaning  will  ])robably  be  neces- 
sary; in  any  case,  other  food  in  addition  to  the  breast 
milk  should  lie  giv(-n  at  once.  One  may  begin  by 
altei-nating  the  nursing  and  the  bottle-feeding  and 
increase  the  numin'i'  of  bottle-feedings  as  may  1m:' 
indicated  by  the  results. 

/\  llifTf  nnij  ohji-rlion  to  a  hnhy  hclng  partly 
iiursi'd  and  parllij  jCd .' 

None  wh;il(-\'ei' :  it  is  often  better  from  the  out- 
set to  feed  llie  baby  dui'iuir  the  night,  in  order  n^t 
\i>  di-turb  llie   mother's  re-t. 

11  IkiI  s//,ii ji/'i/ns  iiid/rnh'  (lull  flic  ill')/ licr's  mdli 
d  is<iijr('(  s   in  III   llie   cliild/ 

llie  child  .-utl'ei'-  t'l'iiin  aluio-t  cuiistant  discom- 
ioi't  :    -Iccjis    litlle    and    then    re~tlesslv.    crie-    a    ii'reat 


48  THE   CAKE   AND    FEEDINC.    OF   ('IIILDIIEN 


deal,  1k»]('1ios  ua^  from  tlie  stoiuacli,  and  ])asri(»s  much 
bv  the  b()\v(ds,  or  if  not  ])assed,  the  gas  accumidates 
and  causes  alxk^minal  distention  and  colicky  ])ain. 
There  may  be  vomiting-,  but  more  often  the  trouble 
is  intestinal.  Sometimes  the  bowels  are  constipated, 
but  usually  the  movements  are  frequent,  loose,  green, 
contain  mucus  and  arc  passed  with  much  gas. 

What  should  he  done  wider  these  circiDtistances? 

If  the  sym})toms  have  ])ersisted  for  two  or  tliree 
weeks  and  the  child  is  not  gaining  in  weight,  there 
is  little  chance  of  im])rovemcnt,  and  the  child  should 
be  taken  from  the  breast  at  once.  If  there  is  some 
gain  in  Aveight,  one  may  try  for  a  little  longer,  en- 
deavouring to  improve  the  moth(n''s  milk  by  rest, 
fresh  air,  careful  diet,  etc.  However,  one  should 
always  realize  that  the  trouble  is  with  the  milk,  not 
with  the  child. 

^^]^at  changes  should  he  made  if  a  nursing  infant 
hahitually  vomits? 

If  this  occurs  soon  after  nursing,  the  infant  has 
usually  taken  too  much  and  the  time  of  nursing 
should  be  shortened,  or  one  breast  nuiy  be  given 
instead  of  two;  the  nursing  should  also  be  inter- 
rupted by  occasional  rests,  so  that  the  milk  is  not 
taken  too  fast. 

If  the  vomiting  occurs  some  time  after  nursing 


WEANING 


49 


jiiul  i>;  re})eate(l,  it  is  a  sigii  of  inJi<restion ;  often 
because  the  milk  is  too  ricli  in  fat.  The  intervals 
betwe<'n  nursing's  should  then  be  lengthened ;  the 
breast  milk  may  be  diluted  by  giving  one  or  two 
tables] xinnf Ills  of  ])lain  boiled  ^vater,  lime-water,  or 
barley-water,  five  or  ten  minutes  before  nursing;  the 
mother  should  cat  less  hearty  food,  especially  less 
meat. 

Wlinf  sltould  he  done  if  fJte  infant  Jias  frequent 
or  Itdhilii'd  colie? 

'Y\\\<  is  usually  because  the  milk  is  too  rich  in 
])rotci<U;  the  mother  should  take  more  out-of-door 
excrei.-e.  eat  less  meat,  and  seek  to  coiitrol  her  emo- 
tions;  all  causes  (»f  worry  should   be  removed. 

('an  eonstipation  in  a  nursinij  infant  he  con- 
trol led  tliroufiJt  the  niolln'r's  }aill'.' 

Only  to  ;i  limited  extent.  It  is  important  that 
the  mother's  bowels  be  regidar  aud  her  digestion 
gooil.  All  increase  in  the  meat  and  milk  of  her  diet 
is  sometimes  beiieiicial. 


W!:AXTX(r 

.1/  iidiat  (Ujr  sJioidd  the  cltild  he  irenncd  fnnn, 
thr  hrrasi? 

I'sually  weiiniug  should  be  begun  at  nine  or  ten 
inoiiljis  by  subst  it  lit  iug  one  feeding  a  day  for  one 
1 


50         TIIK   CAKE   AND    FEEDING   OF   CHILDREN 


luii'sinii',   later  two  fcvdiniis,  ami   thus  i^radmilly  the 
chikl  is  to  be  taken  from  the  breast  altogether. 

}Vliaf  is  (lie  principal  fcasoii  for  ircdiuiKj  earlier- 
The  most  important  one  is  that  the  child  is  not 
thriving — not  gaining  in  weight  and  not  progress- 
ing normally  in  its  develo])nient.  Serious  illness 
of  the  mother,  or  })regnancy,  uu\y  make  weaning 
necessary. 

.^^1/  what  age  should  ihe  weaning  he  completed? 

Generally  at  one  year.  In  sununer  it  nuiy  some- 
times be  advisable  to  nurse  an  infant  a  little  longer 
rather  than  wean  in  warm  weather ;  but  even  then 
the  dangers  of  weaning  are  much  less  than  those  of 
continuing  to  nurse,  as  is  so  often  done,  after  the 
milk  has  become  very  scanty  and  poor  in  quality. 

W]iC7i  shoidd  a  child  who  is  weaned  from  the 
breast  he  taught  to  drink  from  the  cup,  and  when 
to  take  the  bottle? 

If  w'eaning  is  done  as  early  as  the  eighth  or  ninth 
month  it  is  better  to  give  the  bottle ;  if  from  the 
tenth  to  the  twelfth  month  the  infant  should  be 
taught  to  drink  or  be  fed  with  a  spoon. 

How  may  some  of  the  difficulties  iii  weamng  he 
overcome? 

Bv  feedini)'  everv  nursing  infant  once  a  dav  or 


WKANING  51 

by  giviiiii'  it  water  reiziilarly  from  a  feed inti'-bot tie. 
Jt  then  Ih'coiiic's  aeeiist(iiiic(l  to  \\iv  bottle.  This  is  a 
matter  of  ni-cal  convenience  diirini:-  the  whole'  ]>erioJ 
of  nnrsinii'  wlien  the  moilier  or  nurse  is  from  neces- 
>it_v  away  from  the  eliihl  for  a  few  hours;  wlien 
more  feed inu'  is  required  at  ^\•eaning■  time  the  child 
does  not  object. 

WJien  sJiouId  a  child  he  ircancd  from  the  holtJc? 

With  chi]<iren  who  are  not  ill,  weaninii'  from  the 
bottle  shouh!  invai'iably  be  Ix'ii'un  at  the  end  of  the 
tirst  year,  and  after  a  child  is  thirteen  or  fourt<'en 
months  old  the  Ixjttle  shoidd  not  be  given  excej)!  at 
the  night  feeding. 

7.S  ihcre  nrnj  ohjeciion  io  ilio  rltUd's  iaJc'tng  Uie 
Ixddc  iDilil  if   is  tiro  or  Hirer   i/rars  old? 

There  are  no  advantages  and  sonie  serious  objec- 
tion-. Older  children  (d'ten  become  so  attached  to 
the  bottle  that  oidy  v.illi  the  greatest  ditliculty  can 
they  be  made  to  gi\-e  it  n]t.  b'rcMpiently  they  will 
refuse  all  .~olid  food,  and  will  take  nothing  excejtt 
ii'om  the  bottle  so  long  as  it  is  gi\cn,  and  when 
liiially  at  tlii'(-e  or  four  years,  it  i-  taken  away,  they 
\>.iil  not  touch  ndlk  during  the  rest  of  their  child- 
hood. 'I  he  dililcidty  i~  hei'e  that  cliildl'eii  foriu  the 
"bottle  habit."  'idd-  habit  i-  I  I'oidilc-ome,  unneces- 
~ai-\-,    and    .-lionld    b\'    all    mc;in~    b<'    pi'ev<-nte< j.       An 


TIIK   CARE    AND    FKHDING    OF   ('IIIU)KEN 


oxchisivo  diet  of  milk  for  cliildron  of  two  or  three 
Years  often  results  in  ana'niia  and  nialnntrition. 

How  should  one  train  a  child  lo  do  without  the 
bottle? 

This  is  iisnally  very  easy  if  it  is  hegun  at  oiie 
year.  The  milk  shonld  be  poured  into  a  tiny  glass  or 
cup  and  little  by  little  the  child  is  taught  to  drink;  at 
first  only  a  small  portion  of  the  food  is  taken  in  this 
way,  the  balance  being  given  from  the  bottle;  but  in 
the  course  of  a  few  weeks  the  average  infant  learns 
to  drink  from  a  cup  without  difficulty,  and  all  the 
food  can  be  so  given. 

If  the  child  is  two  or  more  years  old,  the  only 
effective  means  of  weaning  from  the  bottle  is  through 
hunger.  The  bottle  should  be  taken  away  at  once 
and  entirely,  and  nothing  allowed  except  milk  from 
a  cup  until  the  child  takes  this  willingly.  Sometimes 
a  child  will  go  an  entire  day  without  food,  occasion- 
ally as  long  as  two  days,  but  one  should  not  be 
alarmed  on  this  account  and  yield.  This  is  a  nuitter 
of  the  child's  will  an(1  not  of  his  digestion,  and  wlien 
once  he  has  been  conquered  it  is  seldom  that  any 
further  trouble  is  experienced.  As  soon  as  a  child  has 
learned  to  drink  his  milk  from  a  cup.  cereals  and 
other  solid  foods  may  gradually  be  added  to  the  diet. 
The  educational  value  of  such  training  is  not  the 
least  important  consideration.- 


WEANING  53 

C<in  a  hdhi/  jusi  irenued  takf  cow's  milk  of  the 
same  proporfions  as  one  of  the  same  age  wlio  Itas 
had  coir's  uiiJk  from   hirih  ^ 

^'erv  rarclv  ;  to  uive  a  bal)y  wlio  lias  had  notliinir 
l)ut  the  breast  from  birth,  jilain  eow's  milk,  or  even 
that  milk  whieh  a  bottle-fed  baby  of  the  same  ag'e 
miiibt  tak{\  is  almost  eertain  to  eause  indigestion. 
'Die  (diaiiiie  in  the  food  is  quite  a  marked  one,  and 
should  be  made  o'raduallv  bv  beninning-  with  a  very 
weak  milk  and  inereasinji-  its  strenu'th  as  the  baby 
becomes  accustomed  to  take  cow's  milk. 

\Vhat  would  he  fhc  proper  proportions  for  an 
i/ifanl  treaned  at  four  or  pre  months? 

About  the  same  as  for  a  heallby  bottle-fed  infant 
of  two  months;  lli(^  quantity  oi  course  sh.ould  be 
hn'<:-er.  'i'lie  food  can  iii  uiost  cases  l)e  a-radually 
iuci'ease(l  so  that  in  two  or  thi'ce  weeks  the  usual 
>rn'iiath  foi-  the  aiic  can  be  taken. 

\\  hat  iroutd  lie  the  proper  propart lons  for  an  in- 
fant  irrancd  at  nine  or  tm  nionllis.' 

About  the  same  as  inr  a  Ixittle-fed  iiifant  at  four 
or  li\'e  moTuhs,  to  be  iti'-rea-(-<l   a-   iii<licate(l  a])ove. 

Wilt  )int  a  child  /'/.ST  /'//  irri<iht  irjidi  placed  upon 
M/  h/ir  a  il II  t  ' 

\'ei'\'  (it'ieii  it  will  do  so  tor  the  tir~t  w<'ek  or  two, 
but    at'tei'    that    will    aain    (]uit('    rei^^ulai'ly  ;    the    acute 


54  THK   CARE    AND    FKKDINC.    OF   ('IllLI)KKN 


iiulii;(>stion,  liowever,  wliicli  oenorallv  accompanies 
till'  use  of  stroniKM'  milk  will,  in  most  cases,  cause  a 
greater  loss. 

AKTIl  rciAI.     1  K.KDIXG 

WJidf  foods  contain  all  llie  elcmenis  present  in 
viother's  nrilh  ' 

The  milk  of  other  animals, — cow's  milk  being 
the  o\\\\  oue  Avhich  is  available  for  general  use. 

Is  it  not  possilAe  for  infants  to  thrire  upon  other 
foods  than  those  containing  fresli  milk'? 

They  luay  do  so  f<n'  a  time,  but  never  perma- 
iieutlv.  The  long-continuetl  use  of  other  foods  as 
the  sole  diet  is  attended  with  great  risk. 

WJiat  are  tlie  dangers  of  such  foods? 

Fre(]uently  scurvy  is  produced  (see  page  141), 
often  rickets,  and  in  other  cases  siuiply  a  condition 
of  general  malnutrition, — the  child  does  not  thrive, 
is  pale,  and  its  muscles  are  soft  and  Habby. 

THE  SELECTION   AX'D   CAKE   Ol'   ^IIEK    USED   FOll  INEANT 
EEEDIXG 

WJiat  are  the  essential  points  in  milk  selected  for 
the  feeding  of  infants! 

That  it  comes  from  healthy  cows,  and  that  it  is 
clean  and  fresh. 


THE   SELECTION    AND   CAKE   OF    MILK 


Is  il  not  Imporldnt  id  seJcci  a  rich  imlkf 
By  no  means:  in  fact  tlic  very  rich  milk  of 
liiiilily  lii'cd  -Icrscvs  and  Aldcrncys  has  not  benai 
foiind  nearly  -o  sarisi'a<-rory  in  infant  fccdinii'  i^^  tliat 
frnm  some  oflicr  ]ier(l<.  --nch.  for  cxamjjle,  as  tlio 
eomm<;>n  "'  erndc  cows." 

Wh'ii-h  i<  llic  Ix'ticr.  III/]!,-  Jnnn  (nio  cov  or  {lie 
iiu.rrd   null,-  of  ^cn-ral  coirs! 

The  mix(Ml.  or  '"  licrd  milk."  is  nsnally  to  be  pre- 
ferred. >ince  it  varies  little  from  day  to  day  ; -while 
that   from   a   ,-int;le   cow  may  vary  considerahly. 

lli)ir  fresh  IS  il  nnportant  thai  coir's  iiiilk  should 
he  for  llir  best  results  in  nijnnt  fcednuj! 

This  depends  very  mncli  njion  the  season,  and 
how  cai'et'idly  milk  is  handled.  As  oi-dinarily  han- 
<]le<j  at  the  dairy  and  in  the  home,  milk  shonld  not 
he  UM'd  for  infant-  in  winter  after  it  is  forty-einht 
hours  old;  in  <ummer  not  after  it  is  twenty-foiir 
hours  old,  and  it  luay  he  nnsafe  in  a  much  short(M" 
time.  When  handled  with  especial  care  milk  nuiy  Iw 
sale  for  a    longer  time. 

What  an'  the  tiro  cssculiats  lit   haudlhuj  rnUl\- ! 

1.  'I  hat  it  he  kept  (dean  and  iwo  fi-om  contaiui- 
iiation.  This  necessitat<'>  tiiat  cow<,  stahles,  and 
milkers  he  dean,  and  that  t  ran<|iortat  ion  he  in  s(^aled 
hottje,-:   al>o  that    tho>e   who   jiaiidk'    the   milk   do   not 


56         THE   (WRE   AND   FEEDING   OF  CHILDREN 


coiiic  ill  contact  witli  any  contai^'ions  disease.  All 
iiiilk-])ails,  bottles,  cans,  and  otlu>r  ntensils  with  which 
the  milk  conies  in  contact  shonld  be  sterilized  shortly 
before  they  are  nsed,  by  steam  or  boiling  water. 

'2.  I'hat  it  be  cooled  innnediatcly  after  leav- 
ing the  cows,  and  kejit  at  as  low  a  tcmperatnre  as 
possible ;  to  be  etiicient  this  shonld  not  be  above 
50°  F. 

Milk  produced  nnder  hygienic  conditions  and 
handled  with  special  care  is  sold  in  bottles  in  a  num- 
ber of  cities  under  the  name  of  "  certified,"  "  guar- 
anteed," or  "  inspected  "  milk.  When  available  such 
milk  should  be  used  for  infants.  Of  course  the  extra 
care  bestowed  in  its  production  and  transportation 
increases  the  cost  of  the  milk,  but  the  best  will  usually 
be  found  in  the  end  to  be  the  chea])est. 

How  should  milk  he  handled  in  the  home  when 
obtained  fresh  from  the  cows? 

That  to  be  used  for  infants  should  be  strained 
through  a  thick  layer  of  absorbent  cotton  or  several 
thicknesses  of  cheese-cloth  into  quart  glass  jars  or 
milk  bottles  wdiich  should  be  covered  and  cooled  im- 
mediately, best  by  placing  the  bottles  quite  up  to 
their  necks  in  ice  water  or  cold  spring  water,  where 
they  should  stand  for  at  least  half  an  hour.  That 
required  for  children  who  take  plain  milk  may  now 


THE  sp:lectiox  and  cake  of  milk         5T 

he  j)Oiirc(l  into  half-pint  hottl('>,  stopped  with  cotton, 
and  put  in  the  ice-chest,  or  tlie  coolest  ])lace  possible. 
This  lirst  rapid  coolinii-  is  verv  important  and  ad<ls 
much  to  the  kee[)ina'  qmilities  of  the  milk.  Milk 
loses  its  heat  very  quickly  when  cooled  in  water, 
hut  \erv  slowly  when  it  is  simply  placed  in  a  cold 
r'M»m.  After  standing  four  or  five  hours  the  top- 
milk  may  be  removed;  after  twelve  to  sixteen  hours 
the  cream  may  be  removed. 

lloir  slionJd  milk  he  handled  ivlicn  bottled  milk 
is  imrchased .' 

Jt  should  l>e  cooled  as  just  descrilx^d,  as  its  teni- 
{)erature  is  usually  somewhat  raised  durina"  trans- 
portation. If  it  has  l)(>en  bottled  at  a  dairy,  the 
cream  or  the  ti)]>-milk  may  be  removed  after  an  hour 
or  so. 


Ihnr  slundd  iiiillx-  and  cream  Ije  handled  whrn 
Iht'ii  are  purchased  in  hulk! 

Such  milk  should  nevei-  l)e  used  for  infants  when 
ir  is  p<issible  to  obtain  bottled  ndlk,  as  it  is  much 
more  liable  to  contamination,  llotji  ci'eam  and  milk 
.-hould  be  ])oured  at  once  into  covei'ed  vessels  and 
kept  in  the  coole.-t  phice  possible.  '{"he  cream  and 
top-milk  will  seldom  ri-o  upon  <nch  milk  with  any 
-atisfactorx-    rf^i^'idarii  >. . 


08  THE   CAKE    AND    EEEI)IN(;    OF   CIIILDIJEN 

W'hdf  arc  flic  iniporfaiit  llii)i(js  to  be  sccura]  hi 
ji  ur.'^cri/  rcfrifjcralofs  * 

Absolute  cloiuiliiioss  is  essential;  lience  the  inner 
]H)rtion  should  h(»  (tf  metal.  Those  made  entirely 
of  metal  are  nnsatisfactory  as  in  them  the  ice  melts 
v(^rv  quickly.  If  the  ordinary  metal  refrigerator 
sold  is  encased  in  a  \vooden  box,  avc  have  the  best 
form.  Another  easy  way  of  secnrinii-  the  same  result 
is  to  make  for  the  refriaerator  a  covering-  or  "  cosey  "' 
of  felt  or  heavy  quilting:,  which  can  he  easily  re- 
moved when  wet  or  soiled. 

The  compartments  of  the  refrigerator  should  be 
so  arranged  that  the  bottles  of  milk  are  either  in 
contact  with  the  ice  or  very  near  it.  The  snpply  of 
ice  shonld  ])e  abnndant.  Often  the  amoinit  of  ice  is 
so  small,  and  the  bottles  so  far  away,  that  the  tem- 
])erature  of  the  milk  is  never  below  60^  or  G5°  F. 
To  be  really  effective  a  refrigerator  should  have  a 
temperature  where  the  milk  is  placed  of  not  over 
50°  F.  The  tem]xn-atnre  shonld  l)e  tested  with  the 
nnrsery  thermometer  from  time  to  time  to  ascertain 
Avhat  residts  arc  being  obtained.  Spoiled  milk  owing 
to  a  fatilty  refrigerator  is  to  be  blamed  for  many 
attacks  of  acnte  illness  among  infants.  Xext  to  the 
feeding-bottles  it  is  the  one  thing  in  the  nursery 
which  shonld  receive  the  closest  attention. 


tup:  modification  of  cows  milk 


59 


THK     MODII  ICATIOX     OF    COW  S     MILK 

(an  c(jir\-<  milk  be  fed  fo  inftntts  irtlhuut  ani/ 
chnnfjes  f 

.\  u  :  fnr  idtliouiili  it  contains  siniilai'  clcnicnrs  to 
riiosc  in  niotlicr's  milk,  tlicv  arc  not  identical,  and 
tlifv  arc  n<it  present  in  the  same  ])i'<»])orti(.ins. 

Is  iJi'is  a  mailer  of  much   Duporlanee? 

It  is  (d"  tlic  greatest  im])ortance.  Tlicrc  are  few 
infants  \vlio  can  diacst  cow's  milk  nnless  it  is  cliang-cd. 
d"o  ciiange  cow's  nnlk  so  as  to  nnike  it  m(jre  nearly 
rc-emble  mother's  miik  is  called  modifijintj  cow's 
milk. 

I  fair  IS  llns  milk  whose.  j)roji(}iiions  Jiave  hern 
rhnn'jcd  (/i.slingins/ied  front  llie  orlt/inal  uneltanijeii 
m'llk^ 

The  chaniz'cd  milk  is  nsiially  calle(l  "  moditieil 
ndlk"":  the  oidiiinal  unchaniicd  ndlk  is  knuwn  as 
■■  plain  ndlk,""  "  whole  ndlk,""  "  straiii'ht  ndlk,""  or 
i-  r(d'ei-red  to  simply  as  '"  ndd-:."" 

II  Jtal  are  the  principal  differences  helireen  coir's 
mill,'  and   mollier's  nnlL'f 

( 'ow"s  ndlk  has  a  little  more  tlian  half  as  much 
~ni;ar:  it  has  Tie;irly  three  times  as  much  ])i-oteid- 
and  ~alt>:  its  ])i-otei(U  ai'c  (Mtrei-eiit  and  much  m<ire 
ditiicult  of  (|ii:e,-tion:  it-  i-eaciion  is  dc(Mdedly  acid, 
di:ii   of   mother'-  milk    i-    I'aiiitK'  acid  or  neutral. 


60         THE   C'AUK    AND    FKEDINU   OF   C'lIILDUEN 

Arc  ihere  anij  other  nnporUini  ihingx  to  he  con- 
sidered? 

Yes;  mother's  milk  is  always  fed  fresh  and  is 
jiractically  sterile.  Cow's  inilk  is  generally  kept 
Twenty-fonr  hours  and  sometimes  mnch  longer.  It 
is  always  to  a  greater  or  less  degree  contaminated 
by  dirt  and  germs,  the  number  of  which  increases 
rapidly  (1)  \vith  the  age  of  the  milk;  (2)  in  propor- 
tion to  amount  of  tlie  dust  or  dirt  which  enters  it ; 
(3)  with  any  increase  in  the  temperature  at  which 
the  milk  is  kept. 

It  is  just  as  important  for  success  in  infant  feed- 
ing that  these  conditions  receive  attention  as  that 
the  proportions  of  the  different  elements  of  the  milk 
are  right. 

How  is  the  acidity  of  cow's  milk  overcome? 

By  the  addition  of  lime-water  or  bicarbonate  of 
soda.  If  lime-water  is  used,  one  ounce  to  twenty 
ounces  of  food  is  generally  required  ;  if  soda  is  used, 
twenty  grains  to  twenty  ounces  of  food. 

If  there  is  a  tendency  to  constipation  the  milk 
of  mag-uesia  (Phillips's)  may  be  used;  from  one  half 
to  one  teaspoonful  being  added  to  each  twenty  ounces 
of  food. 

How  is  the  sugar  heM  increased? 

Bv  addinff  milk  suo'ar  to  tlie  food ;  one  ounce  to 


Ti]E   MODIFICATIOX   OF   ((JWS   MILK  01 

cucli  T\\cnTy  (luiiccs  of  fooi]  ^vill  aive  the  ])rop(:'r 
i|n;nirity  fur  llie  iirsT  tlirco  or  four  riiontlis.  This 
will  iiiakc  the  |)ro])ortiou  ahouT  tlu'  same  (between  t> 
and  7  ]ier  cent  I   as  in  ninThcr's  milk. 

lluir  should  I  lie  sii(/(ir  he  prepared? 

Sim])ly  (jissolveil  in  boiled  water;  if  the  solnti<jn 
i>  not  clear,  or  if  there  is  a  de})osit  after  standinir. 
it  should  be  tiltcred  by  ])ourin<j:  tlirou<2;h  a  hiyer  of 
absorbent  cotton,  half  an  inch  thick,  which  is  placed 
in  an  ordinary  funnel. 

\\  III  fiol  eane  { (jranulated  )  stxgar  ans)rer  as  well .^ 
Xot  as  a  rule;  h<»wever,  there  are  many  infants 
\\liM  iict  on  very  well  when  cane  suiriir  is  used.  It 
has  the  ad\'autai;'e  of  beiuii"  much  cliea]K'r.  A  jioixl 
i:ra<lc  <d"  milk  sn<:ar  is  sonicwhat  exjKjnsive,  costin<^ 
fmiu  twenty-tive  to  sixty  cents  a  pound,  and  cheap 
>amples  are   apt  to  c()iitain  impurities. 

//"  (d/ie  sn'jar  is  uscd^  irhat  amount  sliould  he 
U'Idrd  .' 

< 'Musiderably  le<s  than  ot  the  milk  sui!,-ar.  T^su- 
ally  about  half  tlie  (pumtity  (  half  an  ounce  to  twenty 
ounces  of  fo(.(l  I  is  as  nmcli  ;i-  nio-;t  infant-  can  di- 
L!f-t.  If  the  same  (piantity  i~  u>cd  as  of  the  milk 
.-ui:-;ir.  llic  food  i-;  made  undid\'  sweet,  and  llie  suii'ar 
i-   Iike]\-   to   fei'Hient    in   the   -toniach    and    cause  coin-. 


THE   CAKE    AND   FEHDINCJ    OF   CHILDREN 


Is  uof  l/ic  jiiirjxtsc  of  Ihc  siKjar  io  sweeten  the 
fdcnl  in  order  to  ludlre  it  pidatable  ' 

Xot  at  all:  aliliouali  it  does  that,  its  real  use  is 
to  funiisli  oii(>  of  the  ('ss<>iitial  clenionts  needed  f(n- 
the  liTOwtli  of  the  hody,  and  the  one  that  is  required 
hy  young-  infants  in  the  largest  (juantity. 

How  do  we  ti'now  flint  ftiis  is  so? 

By  the  fact  that  in  good  l)reast  milk  the  aiuonnt 
of  sugar  is  greater  than  that  of  the  fat,  proteids,  and 
salts  conihined. 

We  liave  seen  iliaf  cow's  Jiiilt^-  tins  nenrhj  tJiree 
times  ns  mueti  proteids  (curd)  nnd  snlts  as  inottier's 
iiiiJh.     Jloir  are  tliese  to  Ije  diministied? 

By  diluting  the  milk. 

11'///  //  ])e  sufficient  to  ditute  ttie  milth  twice  (i.  e., 
add  tiro  parts  of  water  to  one  part  of  iniltx)? 

Xot  for  a  ^•erv  young  infant.  Althongh  this  Avill 
give  ahont  the  quantity  of  ])roteids  jn-esent  in  moth- 
er's milk,  the  ])roteids  of  coav's  milk  are  so  much 
more  difficult  for  the  infant  to  digest,  that  in  the 
heginning  it  should  l)e  diluted  five  or  six  times  for 
mr.st  infants. 

//'  cow's  riiitJi    is  property  diluted  and  lime-water 
and  sugar  added  does  if  then  resemtde  mother's  milk? 
Xo :  the  mixture  contains  too  little  fat. 


G"> 


0)6  THE   I'AHE   AND    FEEDING    OF   ("IlILDREN 

From  a  good  av(>rnii'o  milk,  by  removing  tlic  upper 
sixteen  ounces,  or  one  half. 

From  a  rich  rlersev  milk,  by  removing  tlie  upper 
twenty-two  ounces,  or  about  two  thirds. 

What  /V-  cream  ? 

Cream  is  often  spoken  of  as  if  it  were  the  fat 
in  milk.  It  is  really  the  part  of  theinilk  which  con- 
tains most  of  the  fat.  It  differs  from  milk  chiefly 
in  containing  much  more  fat. 

In  what  ways  is  cream  noir  obtained? 

( 1 )  By  skimming,  after  the  milk  has  stood  usu- 
ally for  twenty-four  hours;  this  is  known  as  "grav- 
ity cream."  (2)  By  an  apparatus  known  as  a  sepa- 
rator; this  is  known  as  "centrifugal  cream";  most 
of  the  cream  now  sold  in  cities  is  of  this  kind.  The 
richness  of  any  cream  is  indicated  by  the  amount  of 
fat  it  contains. 

'['he  usual  gravity  cream  sold  has  from  16  to  20 
per  cent  fat.  The  cream  removed  from  the  upper 
part  (one  fifth)  of  a  bottle  of  milk  has  about  16  per 
cent  fat.  The  usual  centrifugal  cream  has  18  to  20 
per  cent  fat.  The  heavy  centrifugal  cream  has  35 
to  40  per  cent  fat. 


P^OOD    FOR   THE   EARLY   MONTHS  67 


FOOD    1-OK    HEALTHY    INFANTS  ' THE    EARLY    MONTHS 

What  are  the  most  important  points  to  tje  remeni- 
bered  in  modifying  cow's  mitJc  for  feeding  during 
the  earty  montlis! 

That  of  the  diiferent  iiiiiTcdients  of  milk  the 
siiuar  is  most  easily  digested;  the  fat  is  next;  while 
the  ])roteids  are  the  most  ditiicnlt. 

What  relation  sJioutd  tJie  fat  hear  to  the  proteids 
during  tins  period? 

For  most  infants  with  good  digestion  the  best  re- 
sults are  obtained  when  the  fat  is  three  times  the 
])roteids.  However,  this  is  not  true  of  all.  There 
are  many  healthy  infants  who  are  unable  to  digest 
this  pr()])ortion  of  fat,  and  who  do  much  better  when 
the  fat  is  made  only  twice  the  proteids. 

IIoiv  can  one  obtain  formulas  in  whicli  tJie  fat 
is  tliree  times  the  proteids? 

V>\  using  for  dilution  a  10-per-cent  milk  (i.  c., 
uiilk  containing  10  per  cent  fat)  which  serves  as  the 
]irimary  formula  from  which  all  the  other  foi'mulas 
of  this  series  are  derived. 

'  Th(^  (lin'cUons  and  foriiuilas  i,'iven  in  the  followiiij;  patres  jire 
iiitt-inicd  iiiily  for  j^Mudaiicc  in  frcdinj,'  cinldrcii  who  arr  not  sulTcr- 
111^'  from  any  spcc'ial  dist  iirliancf  of  diL;t'stioii  ;  directions  for  .-^ueh 
(■(■iiditions  arc  given  in  a  hiler  (diaplci'. 


68         THE   CAllK   AND   FEEDING   OF   CHILDREN 

In  JO-per-eent  milk  the  fat  is  just  three  times 
the  proteids. 

II ow  can  one  get  the  lO-per-cent  milk? 

(1)  As  top-milk,  as  described  on  page  64;  or,  {-l) 
by  mixing  equal  parts  of  ])lain  milk  and  ordinary 
cream  (containing  about  IG  })er  cent  fat)  ;  (3)  from 
any  of  the  milk  laboratories  it  may  be  ordered 
directly. 

7s  it  hetter  to  ohtain  the  10-per-cent  milk  hy 
using  a  mixture  of  milk  and  cream,  or  as  top-milk? 

If  one  can  get  milk  fresh  from  the  cows,  the  top- 
milk  is  to  be  preferred  on  account  of  freshness.  The 
food  can  then  be  made  up  when  the  milk  is  but  a  few 
hours  old.  In  cities,  if  one  uses  bottled  milk,  the 
upper  third  may  also  be  used.  But  if  one  buys  milk 
and  cream  separately,  it  is  usually  more  convenient 
to  mix  these,  as  the  cream  will  not  rise  upon  milk 
a  second  time  ^vith  any  uniformity. 

How  can  one  ohtain  formulas  in  which  the  fat  is 
twice  the  proteids? 

By  using  for  dilution  a  7-per-cent  milk  (i.e., 
milk  containing  7  per  cent  fat)  which  serves  as  the 
primary  formula  from  which  all  the  other  formulas 
of  this  series  are  derived. 

In  7-i)er-cent  milk  the  fat  is  just  twice  the 
proteids. 


FOOD  FOR  THE  EAKLY  MONTHS        G9 

IIow  can  one  (jet  tlic  l-per-ccnt  m'dkl 
(1)  As  to})-niilk,  as  (leseribed  ou  paiic  04;  or, 
(  l' )  liv  inixiiiii'  three  parts  of  milk  and  one  part 
of  rirdinary  (Id  ])er  cent)  cream;  ('•])  from  any  of 
tlie  milk  laboratories  it  may  he  ohtaine*!  directly. 
As  in  the  case  of  10-per-cent  milk,  the  top-milk  is 
iicnerally  to  l)e  })referred  to  a  mixture  of  milk  and 
cream. 

lloiv  sJiouId  the  food  he  prepared  during  the 
(<irhj   months? 

It  is  convenient  in  calculation  to  make  np  twenty 
ounces  of  food  at  a  time.  The  first  step  is  to  ohtain 
the  10-})er-cent  milk  or  the  7-}K^r-cent  milk  to  be  used 
as  the  ])rimarv  formula.  Then  to  take  the  ninnher 
of  ounces  of  this  that  are  called  for  in  the  formula 
de>ired. 

Xotp:. — One  should  not  nuike  the  mistake  of 
lakiuii'  from  the  top  i>i'  the  Ixittle  only  the  ntimlH'i'  of 
ounces  iiee(led  in  the  formula  as  this  may  iiive  (piite 
a  dilferent  result. 

There  will  he  re(piire<l  in  addition  one  ounce  ot 
milk    su::ar  '    and    one;   ounce   of    lime-water    in    each 


'  If  thf  inilk  suixar  he  mcusurfd  in  tlic  tnilk-ilipiHT,  tw..  scant, 
iiij'|ii'rful~  may  tif  calciilatcil  a^  ono  (iiiiici\  If  iin'a^iirrd  in  a 
laiili-~[.()(,n,   ihn-o   even   tahlcsiiOMnf iil>   may  !"■  <-al(iilati'il   as  unc 


70 


TlIK   t'AllE   AND    FEEDING    OF   CHILDREN 


twenty  (Unices.      IMie  r(\st  of  the  food  Avill  Ik"  made 
up  of  boiled  watei'. 

The^e  foriimlas  written  out  would  be  as  follows: 

First  Sei'ies 
Formulas  for  the  Early  Months  from  10-per-cent  Milk 


Ik 

I. 

II. 

III. 

1      ^^'■ 

1      V. 

10-per-cerit  in 
Milk  sugar. 

2  oz. 
1  " 
1   '• 
17  '• 

20  oz. 

3  oz. 
1  •• 
1  " 
16  " 

4  oz. 
1  " 
1  •' 
15  " 

5  oz. 
1  " 

1       1    u 

,  14  " 

1     6  oz. 
1   " 

T.,iiiio-water 

1   " 

Boiled  water 

13  '• 

20  oz. 

20  oz. 

;  20  oz. 

1  20  oz. 

As  tlie  milk  sugar  dissolves  in  the  water  the  total 
in  eacli  column  Avill  be  exactly  twenty  ounces.  The 
food  is  streno'thcned  by  gradually  increasing  the  milk 
and  reducing  the  "water. 

The  approximate  composition  of  these  formulas 
exj)rcssed  in  jx^rcentages  is  as  follows: 


FORMILA. 

Fat. 

Sugar. 

Proteids. 

1.. 

1.00 
1.50 
2.00 
2.50 
3.00 

5.50 
6.00 
6.00 
6.00 
6.50 

0.33 

II.. 
III.. 

IV.. 

0.50 
0.66 
0  80 

v.. 

1.00 

FOOD  FOR  THE  EARLY  MONTHS 


Second  Series 
Formulas  for  the  Early  MontJis  from  7-per-cenf  Milk 


7-per-ceiit  milk 2  oz.  3 

Milk  sugar 1   "  1 

Lime-water 1    '■  1 

Boiled  water 17  "  16 


I  20  0/..       20  oz. 


III. 

IV. 

5  oz. 

4  oz. 

1    •• 

1   •■ 

1   " 

1   •' 

1.3   •' 

U  " 

20  oz. 

20  oz. 

6  oz. 
1   •• 

1   •' 

i;!  •' 

20  oz. 


The  a])])roxiiiiutc  composition  of  these  furiimlas 
expressed  in  jK'rcentao'es  is  as  follows: 


Formula. 

Fat. 

Sugar. 

Proteids. 

I 

..'         0.70 

5.oO 
6.00 
6.00 
6.00 
6.50 

0.35 

II.. 

HI. 

1.00 
1   40 

0.50 
0.70 

IV 

1 . 7.-) 
2.00 

0..H7 

V  ... 

1.00 

JIouj  i-s  one  to  dccuh;  irhciher  to  use  (he  First  or 
the  Second  S'-nes  of  formulas .^ 

\\\\]\  a  larijc,  stroiiu'  child,  haviiiu'  a  liood  dii^-es- 
tiori,  oi)e  should  use  the  J^'irst  Sei'ies.  With  a 
Miiallcr,  h'ss  vi^oiviiis  child,  whose  diue-tioii  is  not 
.-o  <:o(mJ,  or  with  one  who  does  not  do  well  upon  tlie 
Fir-t    Series,   the   Second    Sei-ies   slioidd    \)o  ns(>d. 


72         THE   CAKE   AND   FEEDING   OF  CHILDREN 

\\  Inj  ts  it  necessary  to  make  the  food  so  weak 
at  first? 

]]ceause  the  infant's  stomach  is  intended  to  digest 
breast  milk,  not  cow's  milk ;  but  if  we  begin  with  a 
verv  weak  cow's  milk  the  stomach  can  be  gradually 
trained  to  digest  it.  If  we  began  with  a  strong  milk 
the  digestion  might  l)e  seriously  upset. 

Iloir  rapidly  can  the  food  Ije  increased  in  strength 
from  Formula  I  to  II,  from  II  to  III,  etc.? 

Xo  absolute  rule  can  be  given.  Usually  we  begin 
with  I  on  the  second  day ;  II  on  the  fourth  day ;  III 
at  one  week  or  ten  days ;  but  after  that  make  the 
increase  more  slowly.  A  large  infant  with  a  strong 
digestion  will  bear  a  rather  rapid  increase  and  may 
be  able  to  take  V  by  the  time  it  is  three  or  four 
weeks  old.  A  child  with  a  feeble  digestion  must  go 
much  slower  and  may  not  reach  V  before  it  is  three 
or  four  months  old. 

It  is  important  with  all  children  that  the  increase 
in  the  food  be  made  very  gradually.  It  may  be  best 
with  many  infants  to  increase  the  milk  by  only  half 
an  ounce  in  twenty  ounces  of  food,  instead  of  one 
ounce  at  a  time  as  indicated  in  the  tables.  Thus 
from  3  ounces,  the  increase  would  be  to  3^  ounces ; 
from  4  ounces  to  4^  ounces,  etc.  At  least  two  or 
three  days  should  be  allowed  between  each  increase 
in  the  strength  of  the  food. 


FOOD    FOR   THE   EARLY    MONTHS  73 


W/iaf  (jeiwral  rule  can  he  (jiccn  for  increasing 
the  food? 

To  increase  -when  the  infant  is  not  satisfied  but 
is  digestino-  well. 

IIoiv  dors  an  infant  sliou-  that  lie  is  not  satisfied? 

He  drains  the  bottle  eagerly  and  cries  when  it  is 
taken  away.  He  often  forms  the  habit  of  sucking 
his  finaers  immediately  after.  He  begins  to  fret  half 
an  hour  or  an  hour  Ijefore  the  next  feeding  is  due. 

In  the  series  of  formulas  giren  in  the  table  the 
(piantities  are  mentioned  for  mailing  ordy  twenty 
ounces  of  food.  Jloir  sJiould  it  he  prepared  udien 
more  titan   ilris  qua7ility  is  needed ? 

It  is  equally  convenient  t(»  make  nj)  25  ounces, 
'<<)  <iunces,  .35  ounces,  or  40  ounces  at  a  time. 

To  nuike — 
25  <)uii(a\s  of  any  formula  add  one  quarter  more  of  each  ingredient. 

ijT)       ••  "  "  "     three  quarters      "        "  " 

40       ••  "  "  'i     twice  a.s  much      "        '• 

Thus  25  ounces  of  I-'ormida  I  would  Iw^  obtained 
by  using  2^  ounces  of  milk,  1  [  ounces  of  sugar  and 
Iim(-wat(-r,  21  {  onnco-;  of  water;  .'10  ounces  of  the 
.-:imc  would  rc(|iiii-c  .'i  oiiiicc<  iiii]l<,  1.',  omice<  lime- 
water  and  >iii;ai',  and  25.',  onuccs  water;  ."15  ounces 
Would   re<|uire  -J!   ounce-  milk,    1.','   ounces   lime-water 


74  THE   CAIvH   AND    FKi:i)lN(;    OF    CIlir.DUEN 


iuid  suuar,  niul  2!*'^  (unices  Avator.  '^Flie  anioimt  of 
Mntor  lu'od  not  \)v  calculatcMl  in  any  case,  but  after 
nieasurinii'  carefullv  tlie  otlier  in<>Te(]ients  (nion<2:li 
Avater  slionld  Le  added  to  brini^;  tlie  total  up  to  the 
amount  re(]uired. 

Ifoir  (/real  an  ittcreaf>e  in  iJic  quantity  slio aid  he 
made  at  one  time? 

One  may  make  np  five  ounces  additional  food ; 
but  the  first  two  days  only  two  or  three  ounces  of 
tlie  additional  amount  sliould  bi^  given;  the  next 
two  days,  four  ounces ;  after  two  days  more,  the  five 
ounces  may  be  g-iven. 

The  increase  in  the  (piantity  given  at  a  single 
fecnling  should  not  be  more  than  a  quarter  of  an 
ounce. 

FOOD    FOR    HEALTHY    INFANTS TlIK     LATER     MONTHS 

JIow  long  sliovld  tlie  fat  he  as  much  as  three 
times  tlie  proteids? 

This  is  seldom  of  advantage  longer  than  three  or 
four  months. 

WJiat  changes  should  tlien  he  made  in  the 
milk? 

After  Formula  V  of  the  First  Series  (6  ounces 
of  lO-per-cent  milk  in  20  ounces  of  food)  has  been 
reached,  the  fat  should  be  increased  very  slowly  for 


FOOD  FOR  THE  LATFPt  MONTHS 


tliis  ])r(>])()rti()ii  ( ■']  per  coiit )  is  near  tlie  limit  for 
most  licaltliv  children.  1'lie  milk  should  now  Ik' 
st!-en2thciied  chiefly  hy  raising-  the  percentage  of 
jiroteids. 

I  loir  Is  (Jiis  acroinpJishril  ^ 

The  l(>-])er-cent  milk  and  the  formulas  derived 
from  it  should  imw  he  discontinuedj  and  those  made 
fi'oiii   T-jM'r-cent  milk  \\m'<\. 

Til  ird  S^'ries 
/  ^I^\)r)nul({s  for  tlir  Later  MonfJis  from  7-per-cent  Milk 


in. 


IV. 


7-[)er-cciit  milk Ida.  S  oz.  9  oz.  [  10  nz.      11    oz. 

.Milk  sugar 1    -  1    ■•  1    '•  J  ••            A  - 

Lime- water 1    ••  1    ••  1    "  1     "          1     " 

I'.oilf'.l   Wilier ri  >•  11    ••  10  ••  I  4    '•  '     ;}    •■ 

r.arl.'v  gruel 0   "  0   ••  0   "  ,  5    "  \     5    •• 

•Jl)  nz.  ,     ','0  i)Z.  'JO  nz.  '  20    oz.         20    UZ. 


Siiico  the  sugar  di-si)l\-c^,  the  total  will  he  twenty 
(tuiiccs  111  each  culiimn. 

Of  any  <d'  the  t'l»I•mula-^,  '!')  ounces  is  made  hy 
ii.-ing  one  (|iiarter  more  df  each  ingredient;  -lO 
('Uiice-,  hy  u.-iiig  ntie  lull'  mure".  'A')  ounces,  l>y  using 
three  (jiiarlers  more;  i<t  ounce-.  1)\'  using  twice  ;i-; 
much.  e.\;ictly  as  de-crihed  in  the  l'"irst  Series  on 
pa-e   To. 


76 


THE   TARE   AND   FEEDING    OF  (IIILDREN 


The  a]>])r().\iniate  ooin})()sitioii  of  these  formulas 
ex})ressed  in  ])ercentag"es  is  as  follows: 


Formula. 

Kilt. 

Sugar. 

I'roteids. 

I 

2.50 

2.80 

;}.i5 

3.50 
4.00 

6.50 
6.50 
7.00 
6.00 
6.00 

1  .  25 

11 

1.40 

HI 

1  55 

IV 

1.75 

V 

2.00 

II ow  should  the  food  he  increased  dur'nxj  tJiis 
period? 

Beginning  with  I  of  this  Series,  which  should 
usually  follow  V  of  the  First  or  Second  Series  (])ages 
70,  71),  the  increase  uiay  generally  be  made  in  a 
week  or  ten  days  to  11  ;  in  about  two  weeks  more  to 
III;  now  more  slowly  to  IV  and  V.  When  IV  or  V 
lias  been  reached,  the  same  formula  may  sometimes 
be  continued  for  three  or  four  months  with  no  other 
change  than  an  increase  in  the  quantity. 

7??  passing  from  Fornnda  V  of  (lie  First  Series  to 
Foniuda  I  of  the  Third  Series  the  proportion  of  fat 
is  at  first  reduced.     Is  this  necessary  or  important? 

No ;  it  only  happens  to  come  so  in  simplifying 
the  calculation.  It  may  be  avoided  by  taking  oif 
at  first  the  upper  I.']  ounces  as  top-milk  and  using 
7  ounces  of  this  in  a  20-ounce  mixture,  in  place  of 


FOOD    FOK   THE    LATEK   :\IONTIIS 


l-"<»rin\ila  1  ;  and  hy  u<ing-  for  the  next  increase  the 
upjK'r  15  ounces  as  tep-niilk,  taking'  of  this  8  ounces 
in  a  2(»-<)unce  mixture  in  jihice  of  Formula  II.  Then 
shouhl  follow  Formula    III. 

^VIl(d  further  addUluii  r.iay  be  made  io  the  food 
of  the  later  inontlia^ 

Fsually  ahout  the  sixtii  or  seventh  month,  fari- 
naceous food  in  the  form  of  gruel  may  be  added,  this 
takiuiT  the  place  of  p)art  of  the  water  and  part  of  the 
suiiar.  ■ 

What  cJianf/es  maij  Ije  made  In  the  food  irhen  the 
infant  has  reaehed  the  age  of  ten  or  eleren  months.' 

The  ])rotei(ls  may  he  still  further  increas(Ml,  and 
the  suiiiir  and  the  lime-water  re(luced  until  plain  milk 
is  ii-iven. 

Jlijir   iiiai/   this  Ijest  tie   done? 

At  lir-t  one  fc(Mliu^-  a  day  of  ])lain  milk  and 
hai'lcy  iirucl  may  he  li'ivcn  ;  later,  two  fee(linixs;  then 
llii'co  tee(lini:s,  etc.  Let  us  su])]»ose  an  infant  to  ho 
takini;-  such  a  moditicil  milk  as  I^'ormula  \\  oi-  \' 
(  [taiie  7fiJ,  >ix  l'cc(liui:s  a  day.  The  plain  milk  di- 
luted oidy  with  harley  iiruel  woidd  at  iirst  replace 
one  of  the-e  t'e<'d  i  ni:- ;  then  J  Wo,  tlir-ee,  four,  etc., 
tliese  ehauiies  lieiiii^'  made  at  intervals  df  nliout  two 
weeks,      'i'lie  pi-opui-|  iuu-  ot'  the  ndlk  and  harlev  u'rutd 


78         TllK   CARE   AND   FEEDING   OF   CHILDREN 

should  at  lirst  be  about  .""•.]  ounces  uiilk,  2h  ounces 
barley;  later,  0  o\inces  milk,  .')  ounces  barley;  still 
later,  7  ounces  milk,  '2  ounces  barlev,  until  finally 
})lain  milk  is  given  to  drink  and  tlie  cereals  given 
sej)arately  ^vitll  a  spoon.  This  is  reached  with  most 
infants  at  fourteen  or  iifteen  months;  with  many  at 
t\v(dve  or  thirteen  months.  Other  forms  of  fari- 
naceous food  may  of  course  be  used  in  the  j)lace  of 
the  barley,  and  in  the  same  ]iroj)ortions. 

With  some  infants  the  addition  of  a  ])inch  of 
bicarbonate  of  soda  may  be  advantageously  made  to 
each  milk-feeding  when  the  lime-water  is  omitted, 
but  with  most  this  is  unnecessary. 

If  the  infant  strongly  objects  to  the  taste  of  the 
milk  wlien  the  milk  sugar  has  been  omitted,  a  small 
quantity  (one  fourth  to  one  half  teaspoonful)  of 
granulated  sugar  may  for  a  time  be  added  to  each 
feeding,  then  gradually  reduced. 

GKNKRAI,    RULES    FOR    (JllDAXCK    IX    THE    USE    OF    TUB 
FOKMILAS    C;iVEX 

It  should  again  be  i^mjihasized  that  these  for- 
mulas are  not  intended  for  sick  children  nor  for 
those  suffering  from  any  marked  symptoms  of  indi- 
gestion. For  such  infants  s])ecial  rules  arc  given 
later. 


GENERAL    lU'LES   FOR   GUIDANCE 


What  ^Jiuidd  he  the  guide  in  deciding  upon  a 
fannula  icith  ir/uch  to  begin  for  a  child  ylio  /'.s  lo  be 
aiii/ictaihj  fed/ 

Tlic  aii'c  and  the  weiiilit  are  of  sonic  importance, 
but  the  Lest  ii'uide  is  the  ei)n(liti(»n  of  the  child's 
diu'cstive  (iruans.  One  shonUl  alwavs  In'U'in  with  a 
wf'ak  torniuhi,  ])arTi('u]arlv.  (  1  )  with  an  infant  ])re- 
vionslv  hreast  fed  :  (  2  1  with  itne  just  weaned,  as  a 
chihl  who  lias  ne\'er  had  cow's  milk  must  at  first 
have  weaker  |)rc>])ortion<  than  the  aii'e  and  the  weiii'ht 
Would  seem  to  indirate;  i '■) }  with  infants  whose  y)ow- 
ei-  of  diiicslion  is  unknown.  If  the  first  formula 
tricil  is  weaker  than  the  (diild  can  diirest,  the  food 
can  !)('  strengthened  cverv  three  or  four  davs  until 
it  is  found  what  the  chihl  is  nlile  to  take.  On  the 
courrarv,  if  the  foi.d  is  ma(h>  too  sti-onu'  at  first,  an 
attack   of   indiiic.-tion    will    pi'ohahiy   follow. 

J/o/r  should  the   food  br    i  iirrotiscd    in   s/  rcU'/l  h  / 
The  tii'st  (---eutial   i^  that    it   he  done  N'cry  a-ra<lu- 
ally;    ahiMi[illy    inci'oa-iniz'   the    food    usually   causes    a 
ili~t  urhaliee    (if    diue-tiou. 

It  IS  ue\(-i'  \\i~e  to  ad\ance  moi'c  ra[)idl\'  in 
st  reiiii't  helling-  the  foo.l  than  fi'oni  one  foi-iuula  to  the 
in-xt  one  ill  an\'  of  the  -ei'ie-  iii\'en  ;  with  mau\'  in- 
t'aiit.-^  it  i-  h<'ttei'  lo  niaki-  the  stej)S  oj'  increa-e  only 
half  a^  area!   a.-  tlio~e    indicated    (  iiauc  7-!). 


80         THE   CARE  AND   FEEDING   OF   CHILDREN 

//(>(/"  rapidhj  sliouhl  iJic  food  he  increased  in 
quant  dij:^ 

The  increase  slioukl  not  be  more  than  a  qnarter 
of  an  onnce  in  each  feedinii",  or  from  one  and  a  lialf 
to  two  ounces  in  a  day. 

AVhen  should  the  food  he  increased? 

In  tlie  early  weeks  an  increase  may  l)e  necessary 
every  few  days ;  in  tlie  later  months  sometimes  the 
same  formula  may  be  continued  for  two  or  three 
months.  It  is,  however,  impossible  to  give  a  definite 
rule  as  to  time.  One  cannot  say  with  any  child 
that  an  increase  is  to  be  made  every  week  or  every 
two  weeks.  A  much  better  guide  are  the  conditions 
present. 

The  signs  indicating  that  the  food  should  be 
increased  are,  that  the  infant  is  not  satisfied,  not 
gaining  in  weight,  but  is  digesting  well,  i.  e.,  not 
vomiting,  and  having  good  stools.  One  should  not 
increase  the  food,  however,  so  long  as  the  child  seems 
perfectly  satisfied  and  is  gaining  from  four  to  six 
ounces  a  week,  even  though  both  the  quantity  and 
the  strength  of  the  food  are  considerably  below  the 
average ;  nor  should  the  food  Ix^  increased  if  the  child 
is  gaining  from  eight  to  ten  ounces  a  week,  even  if  he 
seems  somewhat  hungry.  'J'he  a])jx3tite  is  not  always 
a  safe  cuide  to  follow. 


CiEXERAL    RULES    EMR    GUIDANCE 


SI 


lloir  can  one  know  wheUn  r  the  sIrctKjth  or  the 
(^iia)iliti/  of  the  food  should  be  increased / 

111  The  curly  weeks  it  is  well  tir>t  Tn  increase 
the  >rrcii«:rli  of  the  food,  the  next  tiine  to  increase 
the  (inantity.  then  the  streniith  aiiaiii.  etc-.  After  the 
fourth  or  fifth  niunthj  the  (jnantity,  chietly,  should 
he  increased. 

//'  a  slt(jht  dtst urhanee  or  dtscoinjort  occurs  ajter 
the  food  has  been  slre)i(jlheiu'd .  is  it  (jcsf  In  ijo  back 
to  the  ireah'cr  foriuula  or  to  persist  with  the  new  one'? 

Syiii[)toiiis  (if  minor  disconifort  are  seen  for  a  day 
or  two  with  many  infants  after  an  ordinary  increase 
in  food;  Imt  in  mo>t  cases  an  infant  soon  hecomes 
aecii-IoiiKMl  to  the  stronger  food  and  is  ahlc  to  diizest 
it.  If.  h(iwe\-er.  the  -ymptom-  < d'  distiirhance  are 
markeil,  diic  slidiild  ]irom|itly  iio  hack  to  the  weaker 
formiihi.      The  next  increase  slionld  he  a  smaller  one. 

should  mil'  lie  dtsturlicd  if  far  tin  f rst  tiro  nr 
llir(i  iri  i/,-s  (,j  arlijieial  /eedni//  llie  'jain  iti  ireojlit 
IS   rerij  s/n/ht   ur  ercu    ij    there    is  ikiiic  .' 

.\ot  a>  a  rnle.  if  the  infant  doe-  not  lo-<' 
\'.(di;ht,  i<  perteetly  com  t'ort  ahle.  -lee|)-  nio-t  ( d'  th(! 
iliiio,  and  doe<  not  .-wllei'  from  any  .-yni|iliim-  of  indi- 
;je>tion,  -neji  a.~,  colic,  \-omit  iii;^-.  etc.,  one  ma\'  he  sure 
tiiaf  all  i-  i^oiui:'  well  and  that  the  inl'ant  is  hecnmini; 
MM'(1    to    jii~    new    food.        .\-    the    (ddld'.-    a|i|ietite    im- 


82         THK   CAKK    AXD    FKKDIXCJ    OF   CHILDRKN 


])T()ves  and  his  (li^ostion  is  strong'cr,  the  food  may  be 
iiu'roased  evevv  few  (hivs  and  very  soon  the  gain  in 
weiii'lit  Avill  come  and  will  then  be  eontinuous.  If, 
however,  the  scales  are  watched  too  closely  and,  be- 
canse  there  is  only  a  slight  gain  in  weight  or  none 
at  all,  the  food  is  rapidly  increased,  an  acnte  dis- 
turbance of  digestion  is  pretty  certain  to  follow. 

Is  not  co7istipation  likely  to  occur  if  the  child  is 
on  a  very  weah  food? 

It  is  very  often  seen  and  is  due  simply  to  the 
small  amount  of  residue  in  the  intestine.  Under 
these  circumstances,  if  the  bowels  move  once  every 
day,  one  should  not  be  disturbed  even  when  the  move- 
ments are  small  and  somewhat  dry.  As  the  food  is 
gradually  strengthened,  this  constipation  soon  passes 
off;  wdiile  if  injections,  suppositories,  or  cathartics 
are  used  to  produce  freer  movements,  the  functions 
of  the  bowels  are  likely  to  be  disturbed. 

Under  ivhat  circumstances  should  the  food  he 
reduced? 

Whenever  the  child  becomes  ill  from  any  cause 
whatever,  or  whenever  any  marked  symptoms  of  indi- 
gestion arise. 

JIow  may  tliis  he  done? 

If  tlie  disturbance  is  only  a  moderate  one  and  the 
food  has  been  made  up  lV)r  the  day,  one  third  may  be 


GENERAL    RULES   FOR    Gl'IDAXCE  83 

poured  off  from  the  top  of  cacli  bottle  just  l)efore  it 
i>  uiven,  and  this  quantity  of  food  rej)laced  by  the 
.-aiiie  amount  of  boiled  water. 

If  tlie  disturbance  is  more  severe,  the  food 
should  be  immediately  diluted  by  at  least  one  half 
an<l  at  the  same  time  the  (juantity  iriven  should  Ixi 
reduced. 

F(jr  a  severe  acute  attack  of  indiaestion  the  regti- 
lar  food  should  be  omitted  altog'ether  and  only  water 
gi\en  nntil  the  doctor  has  been  called. 

//'  tlie  food  lias  hccn  rcdiiccd  for  a  dlahirhaiice 
of  t!i(/('sl loii^  ]ioir  should  one  rctiuii  to  tJie  original 
foDKula '! 

While  the  reduction  of  the  fcKxl  should  be  im- 
mediate and  considerable,  the  increase  should  be  very 
i;ra<lual.  After  a  seri<Mis  attack  of  acute  indig-estion, 
when  beainnini;-  with  milk  aa'ain,  it  should  not  b(! 
made  more  tliau  one  iifth  the  oriuinal  strenii'th,  and 
ti'oiii  ten  (lavs  to  two  weeks  should  ])ass  b('t(»i'e  tlu^ 
cliiM  is  brouii'ht  back  to  his  original  food,  whicli 
-lionhl  be  done  vciw  <:radually.  It  is  sui'pri-^ini!,'  how 
loii;;-  a  time  is  rc(piircd  with  yoiin^'  iut'aiits  b(d'or(! 
tlicy  completely  i-cco\-er  from  au  attack  of  acute  indi- 
t:e-tioM.  e\'eii  thoiiiih  it  did  not  >ecm  to  be  very  severe. 
'1  li(-  ^econd  di~t  iii-baiice  alway-;  conies  i  rom  a  slia'hter 
cause  than  tlie    tir>1    one. 


84         THE   CAKE    AND    FEEDING   OE   CHILDREN 


TIIK     ADniTIOX    Of    OTIIKU     I'OODS    TO    MILK 

I  loir  long  should  modified  milk  he  continued, 
irifiiouf  ihe  addition  of  other  food? 

This  depends  iijx^ii  circuiiistanccs ;  usiuilly,  for 
about  six  iiiontlis ;  l)nt  if  the  infant  is  tliriving  satis- 
factorily tlie  milk  may  l)e  used  alone  for  ten  or  eleven 
months ;  with  some  infants  who  have  especial  diffi- 
culty in  digesting  cow's  milk,  it  is  advisable  to  begin 
the  use  of  other  food  at  three  or  four  months  or  even 
from  the  outset. 

Wliat  is  the  frst  thinq  to  he  used  with  milk? 
Farinaceous    food    in    some    form,    usually    as    a 
gruel. 

II ov  are  tJiese  gruels  made? 

They  may  be  made  directly  from  the  grains  or 
from  some  of  the  pre])ared  flours  (page  149).  The 
flours  arc  usually  to  be  preferred  as  being  more  sim- 
ple of  preparation. 

Hon-  should  tliey  he  used  in  mahing  tJie  food? 

They  should  be  cooked  separately,  rather  than 
wirli  tlie  milk;  when  the  food  is  mixed,  they  take 
tl'.i-  ])lace  of  a  portion  of  the  water  in  the  formulas 
gixi'U  on  ])ages  70  and   71. 


TUE   ADDITIOX   OF   OTllEli    FOOl>S   To    MILK       s5 


Iloir  much   of  lite  (jruel  slioiild  Ix    used! 

If  It  is  ])r('|iar('(l  as  rcctniiinciulcc!  (m  pauc  14*,', 
it  may  make  accdrdiui:"  to  circumstances  from  one 
>i.\tli  to  one  half  the  total  (juantity  of  food. 

Whiclt  of  the  faniincf'ou.s  joodt;  arc  to  be  prc- 
jerrvd  ^ 

Thost,^  most  \\>vi\  are  harley.  oatmeal,  arrotwroot, 
and  farina.  There  is  not  much  difl'erencc  in  their 
i]Utriti\'e  value;  oatmeal  gruel  is  somewliat  more 
laxative. 

What  value  do  tlicse  suhslanvi  s  possess  as  injant 
foods/ 

Some  of  the  stai'ch  is  diirested  and  absorbed:  but 
the  chief  \-aIue  of  gi'iiel-  is  lielieved  to  be  that  when 
lidded  to  unlk  they  render  the  curd  more  easily 
di^c-lcd  l»y  preveui  iui:'  it  from  coaanlating  in  ihc 
-lomach  111  large  louiih  ma--.-es.  This  is  certainly 
MMic  witli  maii\'  itifatit-,  but  there  arc-  others  who 
arc  tint  at  all  beiietile(l,  and  not  a  lew  young  infants 
\\lio-c  digc-tioii  is  made  di-tinctly  wor-c  by  the  ii^c 
•  '(  tarinaccou,^  I'ood,  pnrt icuhirh'  when  eni|ihiycd  iii 
.•Mii~id(i'able  c|iianiit\\  'Ihc  addilii'ii  of  grind-  to 
:!iilk    Imi'  ;iII    infaiii-   i-  not    n.  lie   i-ccoinincndci!. 

11//'//  jiirlhir  (iildiiinns  ma//  l>r  niud/'  to  Ihi  dut 
(■[    hinllh//   injiiiils  dii/ni'i    I'm     hrsl    ijiiir' 

liocf    iiiicc,    ihc   whUc  of  (  ;.'ij.    ;iiid    oi-;ini!C    llllcf'. 


8(5         TIIK   CAKK    AND    FEKDING   OF   CHILDREN 

lloir  and  when  may  beef  juice  he  used? 

With  infants  who  are  strong  and  thriving  satis- 
factorily it  may  be  begun  at  ten  or  eleven  months ; 
two  teas})oonfnls  may  be  given  daily,  diluted  witli 
the  same  quantity  of  water,  fifteen  minutes  be- 
fore' the  midday  feeding;  in  two  weeks  the  quan- 
tity may  be  doubled;  and  in  four  weeks  six  tea- 
spoonfuls  may  be  given.  The  maximum  quantity 
at  one  year  should  not  be  more  than  two  or  three 
tables])oonfuls. 

With  delicate  infants  who  are  pale  and  anaemic, 
beef  juice  is  more  important,  and  it  may  often  be 
wisely  begun  at  five  or  six  months  in  half  the  quan- 
tities mentioned. 

WJien  should  ivhite  of  egg  he  used? 

Under  the  same  conditions  as  beef  jnice,  particu- 
larly with  infants  who  have  difficulty  in  digesting 
the  proteids  (curd)  of  milk.  At  six  months  half 
the  white  of  one  eu""  mav  l)e  c'iven  at  one  time, 
and  soon  after  this  the  entire  white  of  one  egg.  The 
best  manner  of  cooking  is  the  "  coddled  "  egg  (see 
page  151). 

When  should  orange  juice  he  hegun? 

Usually  about  tlK>  eleventh  or  twelfth  month  ;  it 
should  be  given  about  one  hour  before  the  feeding; 
two  teaspoonfuls  at  first,  then  one  tablespoonful  at 


OVERFEEDING 


a  Tiiuc.  and  later  tlirce  or  four  tablespoonfiils.  It 
is  jiartieiilarlv  useful  when  there  is  eonsti])arion.  It 
should  ahvavs  \x'  strained,  and  care  should  be  taken 
til  at  it  is  sweet  and  fresh. 

OVKin-KKinXG 

\\'/i(if   is  Nuanl  hi/  orcrfccding? 

(ii\inii-  an  infant  too  niiieh  food;  either  too  mueh 
at  one  time  or  too  frequently.  Overfeedinii'  is  sonie- 
trnies  jjraetised  during-  the  day,  but  is  chiefly  done 
at  niirht. 

Is  n(d  an  iitfanl's  nutural  desire  for  food  a  proper 
(jtiidc  (IS  to  the  quatihtij  (jiren? 

Idle  ajipetite  of  a  ])erfe('tly  normal  infant  usu- 
iilly  is;  but  overeatinii'  is  a  habit  aTadnally  ae(]iiire(l 
and  may  continue  until  twice  as  much  food  as  is 
prnper  is  taken  in  the  twenty-four  liours.  Idiis  habit 
i-  most  fre(iueutly  ^(.'on  in  infants  whose  diii'cstion 
i<  not  (juite  normal  ;  because  of  the  temporary  relief 
from  disc(-»mf<ii't  experienced  by  takinti;  food  into  the 
stomach,  they  (tften  ajipear  to  1k'  hun<):ry  the  greater 
part  of  th(;  time,  esjiecially  at  night. 

\\  hdl  (ire  flic  eaiises  of  orei  j (  ednKj  ^ 
I'he   iiiu.-t,  comuHiU   <iiie    i-   the   haiiit   of   watching 
the  weight  too  clo.-eU-,  an<l  llie  convict  iini  i»n  the  part 


88         TllK   CAKK    AND    FEEDING   OF   CHILDREN 


of  the  inotlior  ov  uiirst^  tliat  IxH-auso  a  child  is  not  so 
larfifo  nor  iiainin^-  so  i-apidly  as  some  other  infant 
of  tlie  same  au'o,  more  food  or  stroni>'or  food  should 
l)t>  iii\'(Mi. 

]Vh(il  liar)!)   )-('s)iIfs:  from  orcr feeding? 

All  food  taken  in  excess  of  what  a  child  can  digest 
Lecomes  a  l)urd(Mi  to  him.  Hie  food  lies  in  the 
stomach  or  bowels  nndigcsted,  ferments,  and  causes 
Avind  and  colic.  When  overfe(Mling  is  longin-  con- 
tinued, serious  disturbances  of  digestion  are  so(-»n 
])roduced.  The  infant  is  restless,  fretful,  constantly 
uncomfortable,  slee])s  badly,  and  stops  gaining  and 
may  even  lose  in  weight.  Such  symjitoms  may 
lead  to  the  niistakfui  conclusicMi  that  too  little  food 
is  given,  and  it  is  acc(n'dingly  increased,  when  it 
should  1)0  diminished.  One  of  the  results  of  long- 
continued  overfeeding  is  dilatation  or  stretching  of 
the  stomach. 

]Vhat  should  guide  one  as  to  the  quantity  of  food 
to  he  given  to  any  infaiit  ? 

(1)  The  size  of  the  infant's  stomach  at  the  dif- 
ferent months;  (2)  the  amount  of  milk  which  the 
healthy  nursing  infant  gets;  {?>)  the  quantities  with 
which  most  children  do  best.  The  table  of  quantities 
and  intervals  of  feedina'.  on  ]^^ge  108,  gives  the  aver- 


LOSS   OF   APPETITE 


89 


au'o  liii-urcs  (]cri\-e(l  frmn  these  sources.  It  is  selilom 
wise  to  lio  licyuiid  tli<>  limits  tliere  stated:  imr  should 
oue  insist  u])oii  i^iviuii-  any  tixt'd  aiiiouur  if  it  is 
(deai'ly  more  tliau  llie  child  \vants  or  can  he  made  to 
lake  cxcejit  hy  continued  coaxiiiii'. 


LOSS    OF    AT  PETIT  K 

WJiaf  is  to  he  done   irlioi   ififlioiif  an]!  oihcr  si'pi'i 
of  Illness  a  child's  ai/p<  tile  (jraduaUii  fails/ 

This  is  often  the  result  of  a  h)na'  jieriod  of  over- 
fciMHnjx  or  tlie  use  of  milk  too  rich  in  fat.  If  in  all 
"ither  respects  the  child  seems  well  and  sim])ly  does 
noi  want  his  food,  it  should  he  oifcred  at  reg'ular 
lioui's,  hut  not  nion.^  f re(|uently  :  <)n  no  account  should 
\\i-  he  coaxed,  much  less  forced,  to  eat,  I'ven  though  he 
lak<'s  oidv  one  half  or  one  third  1  he  usual  (juantity. 
Tlic  intei-\-als  hctwecTi  fecdiniis  should  not  he  short- 
ened hut  I'ather  lcni:lhcne(j.  ()flcn.  with  a  child  a 
yeai-  old,  it  is  necessary  to  I'educe  the  numher  of 
feedinos  to  four  or  even  thi'ee  in  twenty-four  hours. 
\\'at('i',  howe\-er,  may  he  oflci-ed  at  more  fre(]U(mt  in- 
ler\a].-.  'Ihe  food  slio)ild  he  \veakene(l  rather  than 
St  reiiLiI  lien<'d.  No  lii-ealer  uii-take  can  he  made  than, 
heeau-i'  -o  little  i-  tak<-n.  coaxmi:'  or  forcinir  iooii  at 
>liort  inter\als  tlironi;li  feai-  le.-t  the  child  may  los(! 
wei^'ht. 


THE   VAIU^.   AND   FEEDING    OP   CHILDREN 


THE     CHANGED     lA'     TilE     FOOD     KEQUIKED    BY    SPECIAL 
SYMrTO:MS    OR    CONDITIONS 

Infants  -with  weak  digestion  and  those  suifcring 
from  various  forms  of  indigestion  have  often  es])ecial 
trouble  in  digesting  the  fat  of  milk.  To  meet  tlie 
needs  of  such  there  is  requii-ed  a  series  of  formulas 
in  which  the  fat  is  lower  than  in  those  already  given. 

These  formulas  are  obtained  from  plain  milk. 


Fourth  Series 
Formulas  from  Plain  Milk  (containing  Jt-per-cent  Fat) 


I. 

II. 

III. 

IV. 

V. 

VI. 

VII. 

12  oz. 

VIII. 

Plain  milk. . . . 

5  oz. 

6oz. 

7oz. 

8oz. 

9oz. 

10  oz. 

14  oz. 

Milk  sugar 

1  " 

1  " 

1  " 

1  " 

f" 

f" 

i" 

A" 

Lime-water. .  . 

1  " 

1  " 

1  " 

1  " 

1  " 

1  " 

1  '' 

1  " 

Boiled  water. . 

14  " 

13  " 

12  " 

7  " 

6  " 

5  " 

2  " 

0  " 

Barley  gruel .  . 

0  " 

0  " 

20  oz. 

0  " 

4  " 

4  " 

4  " 

5  '^ 

5  " 

20  oz. 

20  oz. 

20  oz. 

20  oz. 

20  oz. 

20  oz. 

20  oz. 

When  larger  quantities  than  20  ounces  are  re- 
quired they  are  calculated  in  the  same  manner  as 
described  on  page  78  in  speaking  of  10-]ier-cent 
milk. 

The  approximate  composition  of  the  formulas  of 


CHANGES   REQUIRED    lU'    SPECIAL   SYMPTOMS     91 


the    Fourtli    Series    e.xpre.'^scd    in    })ereentao-es    is    as 
follows : 


Formula. 

Fat. 

Siigrar. 

6.00 
6.00 
6.50 
6.50 
6.00 
6.00 
5.50 
5.50 

Proteids. 

I... 

II... 

Ill  .. 

1.00 
1.20 
1.40 

0.1)0 
1.00 
1.20 

IV... 

V. 

VI... 

VII... 

1.60 
1 .  80 
2.00 
2  40 

1.40 
1.60 
1.80 
2.10 

VIII... 

2 .  80 

2.50 

U  lui  IS  it  (hat  (in  iiifditf  so  oltcn  coinih  soiiv 
of  it.-<  food  within  a  few  ntoinents  after  finishing  lis 
bottle/ 

I'siKilly  Lecaiise  the  quantitv  is  too  lariie.  Soinc- 
tiiiios  it  i■^  (hie  1o  the  fact  that  the  food  is  taken  too 
raj)i<]lv.  fi'oiu  too  lai'ac  a  hole  in  the  ni])})le.  Jt  may 
l>o  due  to  too  titi'ht  elothint:'.  of  to  niovinii.'  the  child 
ahout  in  <iich  a  \vay  as  to  ])i'ess  upon  the  stomach. 

What  are  the  pnne/jiat  eaiiscs  of,  and  tlie  chaiKjes 
in  tlie  fo(i(t  )-e(jiiife(l  !>//  Iiahiliial  roni it i n;/,  fi'fjitnji- 
tatihti,  or  sfnltnuj  iiji  of  small  ciaaiit it les  of  jooil 
lii'lirrrn    f  red  I  /I'/s ,  ojlcii    rr  iir'l  t  cil   iiiaiii/   times  a   daij.' 

'\'\\\<  \<  always  a  sym])toiii  of  a-astfic  iudiu'cst  ion, 
and  a  iiio.-l  ti-oul)lcsomc  one.  In  such  conditions  the 
fat  an<l  id'tcu  the  suaar  al.~o  .-should  j)e  reduced  and 
the   linie-water   inei'cu-od. 


[>2         TUK   (AUK   AND    FKKDING    OK   t'HILDRKN 


Formulas  madt'  t'roiii  ricli  top-milk  or  milk  and 
cream  -dvc  to  Ix^  avoided.  Those  made  from  7-per- 
cent milk  ai'c  less  likely  to  be  the  cause  of  trouble 
than  tli()>e  fi'om  lO-per-cent  milk;  but  if  the  svui])- 
toms  are  at  all  severe  it  is  better  to  use  instead  of 
tlu^se  the  formulas  of  the  Fourth  Series  derived  from 
))lain  milk. 

Keduction  in  the  sn<iar  may  be  made  by  addinj^ 
oidy  one  half  ounce  of  milk  sugar  to  each  twenty 
ounces  of  the  food  ;  in  severe  cases  the  sugar  may  be 
omitted  altogether. 

It  is  often  advisable  to  double  the  amount  of 
lime-water — i.  e.,  use  two  ounces  to  each  twenty 
ounces  of  food. 

The  malted  foods  and  all  other  foods  containing 
much  sugar  usually  aggravate  the  symptoms. 

The  iuter\-als  between  meals  should  generally  1h^ 
half  an  hour  hunger,  and  sometimes  an  hour  longer, 
than  when  digestion  is  normal. 

The  (]uantity  given  at  a  feeding  should  generally 
be  less  than  with  a  normal  digestion.  Usually  a 
snudlcr  (juantity  of  a  strong  food  succeeds  better  than 
a  larger  (puintity  of  a  weak  food. 

ir//fl/  arc  the  causes  of,  and  food  cJiangcs  re- 
quired hji  a  coiislant  and  c.vccsstcc  formation  of  (/as 
in   the   slnnKich^   Jcadirifj   to   distention  and  pain,   or 


CHANGES   KEgUIKKI)    BY   SPKCIAL   SV.Ml'TOMS     9:'. 


eructafujiis    {hcJchhtrj)    of  gn^  and  oflcn    of  a   sour, 
vafrvij  fiu'tdf 

This  is  often  associated  witli  haliitual  voinitiiiii', 
and  is  due  to  similar  causes,  hut  narticularly  to  the 
suii'ar,  wliich  sliould  he  arcatly  reduced  or  omitted 
eutir(dy. 

What  cJiariges  sJtoiild  he  made  irlnn  there  is 
hafj'dual  colic -^ 

'^riiis  is  oeiicrally  i\\\o  {a  an  accumuhitiou  of  gas 
in  the  intestines  which  forms  tliere  hecause  th(^  pro- 
teids  (curd)  of  the  milk  are  not  diirested.  Tliev 
should  lie  reduced  hv  using  in  the  early  months  a 
weaker  formula — i.  e.,  instead  of  Foi'uiula  ^'  of  the 
Kirst  or  Second  Series,  IV  might  he  used,  or.  for 
a  shoi't  time,  even  ITI.  The  ])rot<'ids  may  he  re- 
duced in  the  middle  ])erio(l  hy  using  weaker  for- 
mulas. If  we  desire  to  I'educe  the  ])roteids  without 
reducing  the  fat,  we  nuiy  change  from  the  Seeon<l 
to  the    I""ii'st   Series. 

Another  meaiis  of  ivdieviTig  hahitual  colic  is  th(> 
M~e  of  partially  peptonized  milk  (  page  11  Ti  i  ;  still  an- 
othei'.  the  dilution  with  hai'ley-water  instea<I  of  plain 
wafer. 

U  hdl  clifUKjc  sliiDild  he  iiKidc  ij  curds  djijiciir  in 
[he  slools  rrt/uhtrli/  or  f rctjiicnll ii  ' 

Thi-     i-     u.-uallv    a--ociated     with    hahitual    colic. 


IM  THE   CAUK   AND   FKKDIXG    OF   C'llILDKKN 

iuid  has  to  he  managed  exaetlv  like  that  condition, 
hv  the  means  jnst  described. 

llow  should  the  7)iilk  he  modified  for  chronic 
co7istipatio7i  ? 

The  constipation  of  the  first  weeks  of  life  has 
been  already  referred  to  (pag'o  82)  ;  it  nsnallv  dis- 
appears as  the  food  is  gradnally  strengthened  in  all 
its  proportions. 

Habitual  constipation  at  a  later  period  is  difficnlt 
to  overcome  by  diet  alone.  It  sometimes  depends 
npon  the  fact  that  the  proteids  are  too  high,  and 
sometimes  that  the  fat  is  too  low.  Hence  it  is  more 
frequent  when  infants  are  fed  ujxni  plain  milk  vari- 
ously diluted  (page  DO),  then  when  7-per-cent  or  10- 
]x^r-cent  milk  is  used,  and  diluted  to  a  greater  degree. 
But  it  is  not  desirable  to  use  a  top-milk  containing 
more  than  10  per  cent  fat  for  this  purpose,  nor  is 
it  wise  to  carry  the  fat  in  the  food  above  4  per  cent 
(i.  e.,  8  ounces  of  10-per-cent  milk,  or  12  ounces  of 
7-}X3r-cent  milk,  in  a  20-ounce  mixture),  or  otlu^r  dis- 
turbances of  digestion  may  be  produced. 

In  some  cases  the  use,  in  place  of  milk  sugar,  of 
ordinary  brown  sugar,  in  half  the  quantity,  is  of 
assistance;  or  of  some  of  the  malted  foods  (Mellin's 
food,  malted  milk,  cereal  milk)  also  in  the  nlace  of 
milk  sui2;ar. 


CHANGES   Rf:QUIKED    BY   SPECIAL   SYMPTOMS     !)3 

The  substitution  of  the  milk  of  magnesia  for  the 
lime-water  as  reeijiiimeiided  on  page  <i(i  will  dficu  he 
found  useful. 

To  infants  over  nine  montlis  old,  orange  jniee 
may  he  given. 

W'lial  special  inodifications  arc  rccjuircd  during 
rrri/  hot  weather? 

During-  the  "warm  season  it  is  well  to  make  the 
j)roportion  of  fat  less  than  during  cold  weather, 
hiiring  short  ])erio(ls  of  excessive  heat  it  should  he 
much  less.  1'he  fat  is  reduced  hv  using  7-per-cent 
milk  in  })lace  of  10-})er-cent  (i.  e.,  the  Second  instead 
of  the  First  Series  of  formulas,  ])age  Tl),  or  plain 
milk  in  })lace  of  the  7-per-cent  milk  in  the  Second 
and  Third  Series  ( ])age  DO).  .Vt  such  times  also  the 
usual  food  should  he  diluted,  and  water  should  he 
gi\-en   freely  hetween  the  feedings. 

What  chancjc.s  siiuald  he  made  in  flic  food  oj  a 
child  vhdj  iri/h  all  Ihe  .signs  of  good  digesl ion,  gams 
verij  mile  or  /lol  al  all  in  ireiglilf 

If  the  cliild  >eenis  hungi'y  the  (pumtily  ot  t'ood 
iiKiv  he  iiici'f'a-cii  :  hut  if  ihc  cliihl  will  not  rcailily 
take  an\-  iiioi-c  in  (pianlity  the  strength  may  he  in^ 
(•i'i-a~cd  li\-  the  u.~c  of  the  next  higher  fonnuia.  (  )n<' 
shouM,  liouc\-ci-,  he  cxtronudy  carcfid  under  tlie>e  eii'- 
cum>tanre<  not   to  coax  or  foivc  a  eliild  ;    t'l  t  ihi-  plan 


96         THE    lAKK   AND    FKKDING    OF   f'HILDKEN 

is  almost  certain  to  cause  disturbance  of  digestion  and 
actual  loss  in  \v(Ma,ht.  A  better  policy  is  tliat  of 
lookinii'  after  the  otlier  factors  in  tlu;  child's  life, — ■ 
the  care,  sleep,  fi-esli  air,  etc.,  for  with  these  rather 
than  with  the  food  the  trouble  often  lies. 

]Vlial  s]ti)ul(l  he  done  irillt  i)ifan{s  icJio  in  spile 
of  (ill  variations  in  the  inilk  conlinue  to  hare  symp- 
totns  of  indif/cstion  and  do  not  tlinrc? 

Exce])t  innuites  of  institutions  wlio  form  a  class 
by  themselves,  most  infants  who  receive  ])roper  care 
thrive  ii])on  milk  if  the  proportions  suited  to  the 
dii>estion  are  uiven.  Still  there  are  some  who  do  not. 
The  nutrition  of  such  is  always  a  nuitter  of  diiiiculty. 

If  a  wet-nurse  is  available  the  em])loyment  of  one 
is  the  thing  most  likely  to  succeed,  ])articularly  if  the 
infant  is  (inder  four  or  ti\'e  months  old. 

If  the  infant  is  older,  or  if  a  wet-nurse  cannot  bo 
obtained,  some  of  the  substitutes  for  fresh  cow's  milk 
nuiv  be  tri(^d.  One  of  the  best  is  condensed  milk, 
Borden's  Eagle  brand,  canned,  being  preferred.  This 
is  more  likely  to  agree  if  the  symptoms  are  chiefly 
intestinal  (colic,  flatulence,  curds  in  the  stools,  con- 
sti])ation  or  diarrluea)  than  if  they  are  chiefly  gas- 
tric (vomiting,  regurgitation,  etc.). 

lion:  sl/ould  condensed  milk  he  used? 

For   an   infant  three    or   four   months    old    with 


CHANGES   REQUIRED   BY   .SPECIAL   SYMPTOMS     97 

?_vin])tonis  of  iiidiii-cstion,  it  should  at  lirst  be  di- 
luted with  16  parts  of  boiled  \vatei-,  or,  sonietinies 
jireferably^  ^vitli  barley-water.  With  iiu])rov(Miieiit 
in  the  symptoms  the  dilution  may  be  made  1  to  14, 
1  to  li^,  1  to  1<),  and  1  to  S,  these  ehangx^s  being' 
gradually  made.  The  intervals  between  feedings 
and  the  (puintities  for  one  feeding  are  given  on 
jiage  lOs. 

llotr  Jong  slioiihJ  condensed  milk  he  continued? 

In  must  eases  it  should  be  used  as  the  sole  food 
for  a  few  Moeks  only.  Afterward,  one  feeding  a  day 
(jf  a  \veak  f(_>ruiuhi  of  moditied  milk  (e.  g.,  Xo.  Ill 
oi'  1  \'  of  the  Second  Series,  ])age  71)  uuiy  be  given; 
later  two  feedings,  and  thus  gradually  the  number 
of  milk  fecdiugs  is  increased  until  the  child  is  tak- 
ing only  moditied  milk. 

('omlensfMl  niilk  is  ]iot  to  be  recommended  as  a 
perjuanent  fo<.i(}  where  good  fresh  cow's  milk  can  be 
obtained. 

W  had  lire  (he  ohjt'chons  lo  i/s  n.se? 

it  is  \ci'v  low  in  t'at  and  proleids,  and  high  in 
sugar.  Thi-^  accounts  t'oi'  its  easy  digestibility,  and 
al-o  cx|ihiin-  why  ciiil(h'cn  I'cai'cd  upon  it  often  gain 
^■(■rv  i-apidlv  in  weight,  yet  have  as  a  rule  but  little 
losistaiK'c.  'Ihev  ai'c  vei'v  jirone  to  develop  rickets 
an«l  souK'timi'S  scui'vv. 


1)8         TIIK   CAKK   AND    FKEDING    OF   CHILDREN 

.1/7'  ///('  pvopvielary  infant  foods  open  to  the  same 
objcrtions  as  condensed  nidk? 

Thcv  are.  AVhat  has  boon  said  of  eondonsed  milk 
aj)j)lies  ('(juallv  wcdl  to  most  of  those  tliat  are  sohi  in 
the  market  as  substitutes  for  milk. 

\Vhat  cJianges  in  the  food  are  required  by  slight 
indisposition  ? 

For  slight  general  disturbances  such  as  dentition, 
colds,  sore  throats,  etc.,  it  is  usually  sufficient  simply 
to  dilute  the  food.  If  this  is  but  for  two  or  three 
feedings,  it  is  most  easily  done  by  replacing  with 
boiled  Avater  an  ounce  or  two  of  the  food  removed 
from  the  bottle  just  before  it  is  given;  if  for  several 
days,  a  weaker  formula  should  be  used. 

Wliat  change^  should  he  made  for  a  serious  acute 
illness  ? 

For  such  attacks  as  those  of  pneumonia,  bron- 
chitis, measles,  etc.,  attended  with  fever,  the  food 
should  be  diluted  and  the  fat  reduced  as  described 
on  ])age  1>5.  It  should  be  given  at  r('gu]ar  int(>rvals, 
rather  less  frequently  than  in  health.  Water  should 
be  given  freely  between  the  feedings.  Food  should 
not  be  forced  in  the  early  days  of  an  acute  illness, 
since  the  loss  of  appetite  usually  means  an  inability 
to  diffcst  much  food. 


CHANGES    REQUIRED    BY    SPECIAL   SYMPTOMS     9i) 


WJiaf  'niimvdlaic  changes  slioithl  Jx'  made  In  iltc 
food  irhen  the  child  is  tahen  udih  an  acuie  aflack  of 
fjasfric  indigeslion  with  repeated  vomiting,  fever, 
pain,  etc.  ? 

All  milk  slionld  Ije  st(>])i)e(l  at  once,  and  only 
Ixiiled  water  i>ivoii  for  ten  or  twelve  hours;  after- 
ward barlev-water  or  ^vlle_v  may  l)e  tried,  Lnt  no 
milk  for  at  least  twenty-four  hours  after  the  voiu- 
itin<i'  has  eeased.  When  heiiimiiniz;  with  nioditietl 
milk  the  (jiumtity  should  he  suudl  and  the  fat 
low,  which  may  he  secured  hy  the  use  of  the  Fourth 
Series  of  formulas  in  the  ])lac(^  of  the  First  or  Sec- 
ond Series.  The  proportion  of  lime-water  may  he 
dotdiled. 


WJiat  changes  should  he  made  for  an  attack  of 
intcsiinat  indigestion  attended  by  looseness  of  the 
ho  ire  Is  .^ 

If  this  is  not  severe  (only  two  or  three  passages 
daily)  the  fat  shotdd  })e  lowered  in  the  manner 
stated  just  ahove,  and  the  milk  should  he  hoiled  for 
five  uiinutes.  If  curds  are  ])resent  in  tlu;  stools,  it 
may   lie  still   further  diluted. 

If  the  (llai-rlHcal  attack  is  iriore  severe,  and  at- 
tended hy  fever  and  foul-smelliuu'  movements  of 
greater  frecpiency,  all  luilk  siiouhl  he  stoppe*!  iiiuu(^- 
diate!\-,  and  ihe  diet  menlioue(j    just   ahove  uuder  the 


100       THE   C'AKK  AND    KKEDING   OF   ClIILDKEN 

Iiead  of  ju'Ute  disturhaucHvs  of  tlic  stoiiiaeli  should  be 
cinployc'd. 

WJiaf  (']ia7ujcs  l)i  fJic  food  slioitld  he  made  ivhen 
ihe  child  ^eems  to  hore  vcnj  little  appetite  and  yet 
is  Tiof  ill? 

Tlie  innnber  of  feedinc:s  should  he  reduced,  the 
interval  being  lengthened  by  one  hour  or  even  more. 
No  greater  mistake  can  Ix^  made  than  to  offer  food 
every  hour  or  two  to  an  infant  who  is  not  hungry. 
Such  a  course  only  ])rolongs  and  aggravates  the  dis- 
turbance. 

W]iat  oilier  conditions  besides  the  food  greatly 
influence  the  child's  digestion? 

Proper  clothing,  warm  feet,  regular  habits,  fresh 
air,  clean  bottles,  and  food  given  at  the  proper  tem- 
perature, are  all  (piite  as  important  as  the  prepara- 
tion of  the  food ;  (juiet  peaceful  surroundings  and 
absence  of  excitement  are  also  essential  to  good 
digestion. 

COM^rOX    MISTAKKS    IX    ^tTLK    MODIFICATIOX    AND 
IX  KANT    FKi:i)IN(; 

I.  In  nsing  modifications  made  from  top-milk, 
mnch  confusion  arises  from  the  notion  that  tojvmilk 
is  a  single  definite  thing,  whereas  its  comjiositiou 
depends  upon  a  great  variety  of  conditions  and,  un- 


COMMON   MISTAKES   IX    MILK    MODIFICATION     101 

less  all  these  are  known,  it  is  impossible  to  tell  how 
stronir  it  is.  Direetions  for  the  removal  of  top-milk 
shouhi  he  ex])licitl_v  followed  (see  ])a,<i'e  •••"j),  or  the 
results  ^vill  he  very  different  from  those  ex])eeted. 

II.  Jn  formulas  c-alliiiii'  for  a  eertain  nuiuber  of 
ounces  of  To])-milk  of  any  aiven  streniith,  the  mistake. 
i>  made  of  ]'cmo\-in:L!'  only  ihe  nundier  of  ounces 
ucimUmI  f(ir  the  formula.  The  pro])er  way  is  to  re- 
move the  amount  reipiired  to  secure  a  top-milk  of 
the  de>ired  strenuTh  and  then  to  take  of  this  tiui 
numhcr  of  ounces  needed  in  the  formula. 

III.  A  rich  dersey  milk  is  used  as  if  it  were 
ordinary  milk.  Tiie  formulas  aiven  in  this  book  are 
chielly  ealculated  on  the  basis  of  a  li'ood  averau'e  milk 
A\liich  contains  about  4  per  cent  fat.  Many  jkm'sous 
have  the  idea  that  the  richer  the  nnlk,  the  more  rap- 
iilly  the  child  will  iiain  in  weii^ht.  and  hence  tlie 
^ujlerio^•ity  of  such  milk  foi'  infant  fecMlinij;.  While 
it  i~  true  that  >oiiie  cliildren  iakinu'  ;i  vei-y  rich  nnlk 
may.  foi-  a  time,  eain  rapidly  in  w<di:lil,  yet  soonei* 
<'V  lalei',  s(-ri<iu--  di-l  ui'bances  of  diiicstlon  are  nearly 
al\\'a\~    jii'oduced. 

I\'.  Tlie  feed  is  increa>ed  too  rapidly,  jiarticu- 
larly  aftei-  -ome  distui'bance  of  diac-t  iou.  If,  in  an 
infant  three  ,,y  fniii'  mouth-  ojd.  an  attack  ot  some- 
vliat  acute  indiii-e-f ion  ncciir-.  the  food  shoidd  sel- 
doiii  liei;i\-en  iu  full  -treni!tli  befoi'e  two  weeks.      The. 


10-2   THE  CAKE  AND  FEHDINC  OF  CHILDREN 


incronso  in  tlie  diet  should  ho  made  very  p:radnall_v, 
tile  ste]is  ])eiiii!:  made  enly  one  lialf  those  indicated  in 
the  seri(>s  of  forninhis  on  j)aii(S  TO  and  71.  Other- 
wist'  it  generally  hap})ens  that  the  attack  of  indiges- 
ti<*n  is  very  much  prolonged  and  much  loss  in  weight 
occurs. 

V.  AVhen  symjitonis  of  indigestion  occur,  the  food 
is  not  reduced  rapidly  enough.  Indigestion  usually 
means  that  the  organs  are,  for  the  time,  unequal  to 
the  work  imposed.  If  the  food  is  imuuMliately  re- 
duced by  one  half,  the  organs  of  digestion  soon  regain 
their  ])ower  and  the  disturbance  is  short.  In  every 
case  the  amount  of  reduction  should  depend  upon  the 
degree  of  the  disturbance. 

PRKPATIATIOX     OF     COw's     :\I  II.K     AT     HOME 

^V]tal  articles  are  required  for  ilie  preparation  of 
cow's  milk  at  home? 

Feeding-bottles,  rubber  nip]iles,  an  eight-ounce 
graduated  measuring  glass,  a  glass  or  agate  funnel, 
bottle^  brush,  cotton,  alcohol  lamp  or,  better,  a  Bun- 
sen  gas  burner,  a  tall  (|uart  cu]i  for  warming  bottles 
of  milk,  a  pitcher  for  mixing  the  food,  a  wide-mouth 
bottle  for  boric  acid  and  one  for  bicarbonate  of  soda, 
and  a  pasteurizer.  Later,  a  double  boiler  for  cooking 
cereals  will  be  needed. 


PREPARATION   OF   COWS   MILK   AT    IIOMI-]       102 


WJiat  holiJcs  arc  to  he  preferred? 

A  cylindrical  ci'iuhiatod  bottle  with  a  rather  wide 
neck,  so  as  to  admit  of  easy  washinii'.  and  one  which 
ciintains  no  ang'h^s  or  corners.  A  sinizle  size  hohlinir 
eiiiht  ounces  is  quite  sufficient  for  use  durini>'  the  first 
year.  All  coni])licated  bottles  are  bad,  1)eina-  dithcult 
to  clean.  One  should  have  as  many  bottles  in  use  as 
the  child  takes  meals  a  day. 

How  should  hoilJes  lie  cared  for? 

As  soon  as  they  are  emptied  they  should  be  rinsed 
with  Cdld  water  and  aHowed  to  stand  filled  witli  water 
to  ^\•hi(•h  a  little  bicarbonate  of  soda  has  Ix'en  ad(le(l. 
Before  the  milk  is  put  into  them  they  should  be 
thoroughly  washed  with  a  l)ottle  brush  and  hot  soap- 
suds and  then  ])laced  for  twenty  minutes  in  boilinc: 
water. 

]Vhaf  sort  of  nipples  slioidd  he  used? 

Duly  sinij)le  straiiibr  nijiples  which  sli])  over  the 
neck  of  the  bottle.  Those  with  a  rubber  or  sxlass 
tube  are  tof)  complicated  and  very  dithcult  to  kec]) 
clean.  Xipples  made  of  black  rubber  are  to  be  ])re- 
forred.  T!ie  hole  in  the  nipple  should  not  l)e  sd  lariic 
that  the  milk  will  run  in  a  stream,  but  just  lai-uc 
enou<:h  for  it  to  drnp  ra])idly  when  the  bottle  with 
tlic   nipple    ;itt;ic|ied    i<    iiiverte<]. 


104       THE   CARE   AND    FEEDING   OF   C'lIILDREX 

lion-  should  i)ljij)l('s;  he  rarcd  for? 

iS'cw  iii])])l('s  should  !)('  lioilcd  for  live  iniuutes; 
but  it  is  inuuH'ossarv  to  r(^])oat  this  ovcrv  dav  as  th(;y 
sooTi  Ikh'oiuo  so  soft  as  to  he  almost  useless.  Afti^r 
iisinir,  iiijiples  slioidd  he  carefully  rinsed  in  cold 
water  and  ke])t  in  a  eovercnl  o-lass  eontainino:  a  solu- 
tion of  horax  or  horic  acid.  At  least  once  a  day 
they  slionld  l)e  turned  wrono-  side  out  and  thoroue:hly 
^vashed  ^vitll  soap  an<l  water. 

^y]laf  sort  of  collon  slionld  he  used? 

Tlie  refined  non-ahsorhent  cotton  is  rather  bettor 
for  stoppering;  bottles,  but  the  ordinary  absorbent 
cotton  will  answer  every  purpose. 

WJiidt  is  Ix'tter,  fJie  Bunsen  burner  or  the  aJro- 
hol  lamp? 

If  there  is  g-as  in  the  honso,  the  Bunsen  burner 
is  <xreatly  to  be  preferred,  being  cheaper,  simpler, 
and  nmch  safer  than  the  alcohol  lamp.  Tf  the  lamp 
is  nsed,  it  shonld  stand  npon  a  table  covered  with  a 
plate  of  zinc  or  tin,  or  n])on  a  large  tin  tray.  The 
French  pattern  of  alcohol  lani])  is  the  best. 

Glre  tlie  directions  for  preparing  the  food  ac- 
cording to  any  of  the  ahore  fonnidas. 

The  nurse's  hands,  bottles,  tal)les,  and  all  ntensils 
shonld  Ik;  scrn})nlously  clean.  First  dissolve  tlie 
milk  sntrar  in   boilinu'  water,   filterinix  if  necessarv. 


DIRECTIONS   FOR    FEEDIXG    INFANTS  105 

Tlien  add  tlio  milk  and  cream  and  lime-water,  mix- 
ins:  the  whole  in  a  })itcher.  A  sufficient  quantity  of 
food  for  twenty-four  hours  is  always  to  he  ])repared 
at  one  time.  This  is  then  divided  into  the  nund)er 
of  feediniis  required  for  the  day,  each  feedinc;  being 
])Ut  in  a  se])arate  bottle,  and  the  bottle  stoppered 
with  cotton.  The  bottles  should  tlien  be  cooled  rap- 
idly by  standing-,  first  in  tepid  then  in  cold  water, 
and  afterward  ])laced  in  an  ice  chest.  If  the  milk 
is  to  be  ])asteurized  or  sterilized,  this  should  precede 
the  cooling. 

DIKKCTIO-NS    FOR    FEEDIXG    IXFA^^TS 

How  sJiouId  the  holile  he  prepared  at  feeding 
time  '* 

It  should  be  taken  from  the  ice  chest,  and  warmed 
])y  standing  iji  A\-arm  wat(>r  wlii(di  is  (hnq)  en<n]gh 
to  covei'  the  milk  in  the  bottl(> ;  it  should  then  be 
lliorouglily  shaken  and  the  ni])])](»  adjusted;  the  nurse 
sho)ild  see  that  the  hole  in  the  uipph;  is  not  too  laru'e 
nor  to()  small. 

]hne  uiaij  tlie  tevi peral are  of  the  miJli-  t)e  tes^ted^ 

.\'c\-('r  b\-  ])iittnig  the  nipple  in  the  niii'sc's  uKiiilh. 

\\c{<<vc    ad|n~ting   the   nipple,    a    teaspootiful    ma\'    be 

piHii'(ii    fi'iiiii    the    jiottlc    ;iiid    tastcil,   (jr    a    few    drops 

may    he    poui'cd    throuub    the    ni[)ple    upon    the  inner 


100        THE   CAHK   AND    FEEDING    OF   CHILDREN 

siirfaco  of  tlio  wrist,  where  it  should  feci  quite  warui 
hut  never  liot ;  or  a  thennometer  uiav  1k^  jihieed  in 
the  water  in  whicli  tlie  l)ottle  stands.  A  dairv  ther- 
mometer shouhl  be  used,  and  the  temperature  of  the 
water  should  he  between  i)S=  and  105°  F. 

WJiai  is  (I  simple  roiilrivancc  for  lyeping  tJie 
huJk  u'a)')n  (hiring  feeding? 

A  snudl  flannel  bai>'  with  a  draw  string"  may  be 
sli]iped  over  the  l)ottle. 

In  vhat  posilion  slioidd  an  infant  iaVe  its  l)ottle? 

For  the  first  two  or  three  months  it  is  better, 
except  at  night,  when  it  niav  be  undesira])le  to  take 
the  infant  from  its  crib,  that  it  be  held  on  the  nurse's 
arm  during  the  feeding;  later  it  may  lie  on  its  side 
in  the  crib  provided  the  bottle  is  held  by  the  nurse 
until  it  has  been  emptied  ;  otherwise  a  young  infant 
readily  falls  into  the  bad  habit  of  alternately  sucking 
and  sleeping,  and  often  will  Ije  an  hour  or  more  over 
its  bottle. 

JIow  muclh  time  sliould  he  alloived  for  one 
feeding? 

Xever  more  than  twenty  minutes.  The  bottle 
should  tlicn  be  taken  away  and  not  given  until  the 
n(-xt  feeding  time.  Under  no  circumstances  should 
an  infant  form  the  habit  of  sleeping  with  the  nipple 
in  its  mouth.     A  sleepy  infant  should  be  kept  awake 


INTERVALS   OF    FKKUIXG  107 


by  gentle  sliakiiiiz-  until  the  food  is  taken,  or  the  bot- 
tle should  be  removed  altogether. 

,'^/ioul(l  an  infani  he  phiycd  ivith  soon  after 
feed  UK j ! 

On  no  aeeonnt;  such  a  thing  frequently  causes 
\'niiiiring  and  sometiuies  indigestion.  After  every 
feeding  the  infant  should  be  allowed  to  lie  (juietly 
in  its  crib,  and  disturbed  as  little  as  possible. 

I.NTKRVALS    OF     KKKDIXG 

lloir  often  should  a  baby  be  fed  durlncj  the  first 
month  ! 

]'>\-ei'y  two  hours  during  the  day  and  twice  dur- 
ing the  Tiight,  or  ten  feedings  during  the  twenty-four 
hours. 

.1/  irhid  (Kje  may  the  interval  l>e  made  tiro  and 
a  half  hdurs? 

I  sually   at   live  or  six  weeks. 

When   hKiy  it  tie  inrreased  to  three  hour.^.^ 
rsiKtlly  ;i1    two  luonths. 

Why  should  not  (i   child  tie  fed  more  j  nupicntl  y  ! 

It  takes  the  stomach  nearly  two  hours  to  digest  a 
meal  at  tw(»  months,  aud  about  two  and  a  halt"  hours 
at  ti\-e  or  six  mouths,  aud  if  the  meals  are  too  near 
together   the   second   i<\\{'    is   iii\cn    betOre   the    tir.-t    has 


108        TIIK   (ARE   AND    FEEDING    OF   CHILDREN 

bi't'ii  digested  and  vomiting  and  indigestion  result. 
Tlio  meals  should  be  far  enough  apart  to  give  the 
stomach  a  little  time  for  rest  just  before  each  feeding. 


Schedule  for  Feeding  Healthy  Infants  during  the 
First  Year 


Inter-  I  Night  No.  of 
val  he- 1  feed-  |  feed- 
tween  ings  (10  ings  in 
meals,  p.  m.  to  :  24 
by  day.  7  a.  m).  hours. 
I 


Quantity       Quantity 
for  one  for  2-i 

feeding.  liours. 


2(1  to  7th  day !  2 

2(1  aiul  o(l  weeks i  2 

4th  iirid  5th  wt;ck.'< ■  2 

6th  to  8th  week 2^ 

;^(1  to  5th  month i  ?>" 

5th  to  {»th  month j  3 

9th  to  12th  inontli !  4 


Oiin<-<-«. 

Ouncei, 

2 

10 

1  -u 

10-15 

2 

10 

1  .*-;5 

15-30 

1 

10 

2i-:i.^ 

25-35 

1 

8 

'S  -5 

24-40 

1 

( 

4  -G 

28-42 

0 

6 

5  -71 

30-45 

0 

5 

7  -!) 

35-45 

This  schedule  gives  the  averages  for  healthy  chil- 
dren. The  smaller  quantities  are  those  required  by 
small  children  Avhose  digestion  is  not  very  vigorous. 
The  larger  qmmtities  are  those  required  by  large 
children  with  strong  digestion;  in  very  few  cases 
will  it  be  advisable  to  go  above  these  figures. 

'J'lie  interval  is  reckoned  from  the  beginning  of 
one  feeding  to  the  beginning  oi  the  next  one. 

]Vhen  should  tlie  'mtercal  beliveen  (lie  feeding^ 
he  lengthened? 

When   there   is   gastric   indigestion   as  shown   by 


REGULAKITY    IX    FEEDING  109 


habitual  voniitiiio-  or  the  regurgitation  of  food  h)iig 
after  the  bottle  is  finished  ;  also  when  the  appetite  is 
verv  })Oor  so  that  the  infant  regularly  leaves  some 
of  its  food. 

W/icn  should  the  interval  between  the  feedings 
he  shortened? 

This  is  done  much  too  frequently ;  it  is  rarely 
advisable  to  feed  any  infant,  except  one  seriously  ill, 
oftener  than  the  time  put  down  in  the  schedule. 

EEGUT.ARITY    IX     FKKDIXG 

lion-  can  a  hahy  he  taught  to  he  regular  in  its 
hahits  (if  eating  and  sleeping? 

V>y  always  feeding  at  regular  intervals  and  put- 
ting t(»  sleej)  at  (^xactly  the  same  time  every  day  and 
evening. 

When  should  regular  (raining  he  hegun? 
During  the  first  week  of  life. 

Should  a  hahy  he  vakened  to  he  nursed  or  fed  if 
sli'('j)Uig  (juietly? 

Vc--.  i'ov  a  few  days.  This  will  not  be  re- 
(|uii-c<|  Idug.  for  with  i-eguhii'  fcetiiiig  au  infant 
soon  wakes  rcgidarlv  for  it<  meal,  almost  upon  tho 
minute. 


no        TllK   ("ARK   AND    FEEDING    OF   tJHILDUEN 

>^Jioidd  regularity  in  feeding  he  Ixpt  up  at  night 
as  irell  as  during  the  day? 

Only  uj)  to  nine  or  ten  o'clock;  after  that  time  a 
baby  shonkl  be  allowed  to  skx^p  as  lonjr  as  it  will. 

.1/  what  age  may  a  well  hahy  go  without  food 
from  10  1'.  M.  to  (')  or  7  a.  yu? 

Usnallv  at  four  months,  and  always  at  five  or  six 
months.  Night  feeding  is  one  of  the  most  frequent 
causes  of  wakefulness  and  disturlx3d  sleep. 

STERILIZED    :MILK 

WJiat  is  meant  by  sterilizing  niilli? 
Heating    milk    for    the    purpose    of    destroying 
germs. 

Does  all  coivs'  milk  contain  germs? 

Yes;  even  when  handled  most  carefully,  milk 
contains  many  germs ;  but  when  carelessly  handled, 
and  in  summer,  the  number  is  enormous.  While 
]]iost  of  these  are  harmless  or  cause  only  the  souring 
f»f  milk,  others  are  occasionally  present  which  may 
])roduce  serious  diseases  such  as  typhoid  fever,  diph- 
theria, scarlet  fever,  cholera,  tuberculosis,  and  many 
forms  of  diarrha'a. 

Under  what  circumstances  is  it  necessary  to  ster- 
ilize milk? 

1.   In  Avarm  weather  when  it  cannot  be  obtained 


STEIIILIZKI)    MILK  111 


fresh  ;  hence  always  in  cities  and  towns  during  the 
summer. 

2.  Wlien  one  cannot  Ik?  certain  that  the  cows  are 
healtliv,  or  that  tlie  milk  has  heen  carefully  handled. 

.'].  When  the  milk  is  to  he  kept  for  any  consider- 
alile  time  (i.  e.,  over  twenty-four  hours),  especially 
if  no  ice  can  he  had. 

4.  During-  epidemics  of  typhoid  fever,  scarlet 
fe\"er,  di]ihtheria,  or  any  form  of  diarrheal  disease. 

Mlint  arc  tlie  two  mctliods  of  liealing  milh? 

The  tirst  is  known  as  sicrUizing,  in  which  the 
milk  is  heated  to  212^  F.  for  one  hour  or  one  hour 
and  a  half;  the  second  is  known  as  pastcurizhuj.  in 
whicli  the  milk  is  lieated  to  155^  or  170°  V.  for 
thirty  minutes.  A  tem])erature  of  155°  i\  con- 
tinued for  thirty  minutes  is  sutlicient  to  kill  the 
germs  <d"  the  diseases  ahove  referred  to. 

Will  til  ill,-  vJiich  lias  he  en  thus  treated  keep  in- 
de  jiuilcl If ''! 

Xo;  f(ir  although  all  the  living  geruis  may  he 
killed,  there  ai'e  ukitiv  iiudev(do|M'd  germs,  or  spores, 
which  are  not  destroyed,  and  which  soon  gmw  into 
li\'ing  iz'erms.  Milk  heated  to  212  '  l'\  for  an  hour 
will  keep  npon  ice  for  two  or  three  week-;  that 
heated  to   155''   J"".  J'or  two  or  thi'ee  davs. 


112       THK   CARE   AND   FEEDING   OF  CHILDREN 

Is  mill:  which  has  been  slerilized  always  a  safe 
food? 

Xo;  for  tlie  reason  that  the  milk  may  be  so  old, 
so  dirty,  and  so  eontaniiiiated  before  sterilizini^  that 
it  may  be  still  imiit  for  food,  though  it  contains  no 
living  germs. 

Is  coiv's  millc  rendered  morx  digestible  by  being 
heated  in  this  tvay? 

Sterilizing  milk  does  not  improve  its  digestibility 
but  rather  the  contrary.  Sterilized  milk  should  be 
modified  for  infant  feeding  in  the  same  way  as  milk 
which  has  not  been  heated. 

Is  milk  in  any  ivay  injured  by  heating  to  212°  F. 
for  an  liour? 

There  is  abundant  evidence  that  milk  is  ren- 
dered less  digestible  by  such  heating;  also  that  it  is 
more  constipating,  and  that  for  some  children  its 
nutritive  properties  are  interfered  with,  so  that  it 
may  cause  scurvy ;  this,  however,  is  not  seen  unless 
it  is  continued  as  the  sole  food  for  a  long  period. 
These  objections  are  of  so  much  importance  that  this 
plan  of  heating  milk  is  not  to  be  recommended  for 
general  use. 

Whe7i  is  it  advantageous  to  heat  milk  to  212°  F.f 

Tor  use  upon  long  journeys,  such  as  crossing  the 

ocean.      Milk   should   then   be   heated  for  one   hour 


STERILIZED    MILK  113 

iiptai  two  successive  days.  Avitliout  removing  tlie  cot- 
ton stoppers  from  the  bottles. 

Is  milh-  in  any  way  injured  by  heating  to  155^  F. 
for  tliirty  minutes? 

This  ])oint  is  not  yet  definitely  settled.  Sucli 
lieating  does  not  affect  the  taste  of  milk  and  does 
not  render  it  more  constipating.  The  nnfavourabU' 
effects,  if  there  are  any,  are  so  slight  that  they  need 
not  deter  one  from  the  nse  of  pastetirized  milk,  even 
for  h)ng  ])«n"i()ds.  Tlie  preference,  however,  shonld 
always  lie  given  to  milk  wliicli  is  so  clean  and  so  fresh 
as  not  ti-»  require  any  lieating. 

Hoir  sliouJd  milk  In'  pasteurized? 

A  convenient  form  of  a})paratus  is  that  known 
as  l"'i'eciiian's  jiastcurizer  ^  ;  anotlier  is  the  Walker- 
( lordon   ^.tasteuri/.er." 

llov  slioutd  mdk  lie  cooled  ajter  paste  art  zing  ? 

Always  hy  placing  the  bottles  in  cold  water,  so 
as  to  cool  them  rapidly;  iiex'er  hy  letting  them  stand 
at  the  iciiipci'ature  of  the  room,  or  by  placing  them, 
uliciL  warm,   in   an  ice  box. 

'  'I'lii.^  can  lie  ol)tain(Ml  at  411  West  Fifty-ninth  Street,  New 
^'iii-|<,  with  lini  1  li;s  and  full  direct  ions  ;  u  tin  one,  at  a  cost  of  A:!. •")(!, 
and  a  cojij»-r  one,  which  is  much  more  diiralilr,  for  .fT.OO. 

'^  nliiaint'd  at  tlie  same  prices  from  any  of  tlie  Waiju'r-fiordon 
mill-;  lalioratories. 
H 


114        THK   CARE    AND    KKKDINO    OF   CIIILDREX 

117///  is  I  his  precaution  necessary? 

Cooliiiij;  in  the  air  or  in  tin  ice  box  requires  from 
1\vo  to  four  liours,  and  durinc;  that  time  a  great  many 
of  the  undeveloped  Ji'ernis  niav  mature  and  greatly 
injure  tiie  keeping  ])roperties  of  the  milk.  In  the 
eohl  water,  milk  can  be  cooled  in  from  ten  to  twenty 
minutes  if  the  water  is  frequently  changed,  or  if  ice 
is  added  to  the  water. 

MODIFIED    MILK    OF    THE    MILK    EABORATORIES 

What  is  "  modi/ied  milk "  of  the  milh  labora- 
tories? 

It  is  milk  containing  definite  proportions  of  the 
fat,  sugar,  proteids,  etc.,  j)ut  up  usually  according 
to  the  prescription  of  a  physician,  who  indicates  how 
much  of  the  different  elements  he  desires.  The  most 
reliable  are  the  laboratories  of  the  Walker-Gordon 
Company,  which  has  branches  in  many  of  the  large 
cities  of  the  United  States. 

This  is  an  excellent  method  of  having  milk  pre- 
])ared,  since  it  can  be  done  with  greater  care  and 
cleanliness  than  are  possible  in  most  homes.  It  is 
besides  a  great  convenience  if  circumstances  make  it 
impossible  to  prej^are  the  milk  properly  at  home. 

The  laboratory  should  be  used  for  infant  feed- 
ing only  by  one  wIkj  is  souiewhat  familiar  with  this 
method  of  orderin<>'  milk. 


PEPTONIZED    MILK  115 


I'Kl'T().\r/.l,l>     MIT.K 

Wit  fit  is  peptunizcd  at  ilk.'' 

^lilk  in  whieli  the  j)rotci(]s  (curd)  liave  been  par- 
tially digested. 

JI(jir  is  this  accomplished? 

V>\  the  aetion  of  a  jiejitonizing  powder  which  is 
conij)osed  of  a  digestive  agent  known  as  the  extractuni 
])ancreatis  and  hiearboinite  of  soda,  wdiieh  is  added 
to  the  ])lain  or  diluted  milk.  This  is  sold  in  tubes 
or  in  tablets,  and  it  is  the  active  ingredient  of  the 
])C])togenic  milk  ])ow(ler. 

Dcscrihe  the  process. 

The  ])lain  or  modified  milk  is  ])laced  in  a  clean 
glass  jar  or  l)ottl(»,  and  the  pe])tonizing  powder, 
which  is  first  rubbed  uj)  with  a  tablesjjoonful  of  the 
milk,  is  added  and  the  bottle  shaken.  The  bottle  is 
then  ])laced  in  a  large  ])itclier  or  basin  cnntiiining 
water  kept  at  the  teni])erature  of  about  1  10°  F.,  or  as 
warm  as  the  hand  can  Iw'ar  coiiifoi'tablv,  and  left  for 
leii  to  t\v<'Uly  minutes  if  the  milk  is  to  be  ])artially 
jteptoiiized  ;  for  two  hours  if  it  is  to  b(^  comjiletelv 
p<-ptoiii/.e(k 

What  Insic   has  partially  peptonized   milk? 
Xi'iie,    it'    [K'ptoni/.ing    is   eoinitiiKMl    for   oidy    teu 
iiiiniite<.  liut    at    tiie  end   of  twciitx'   minutes  it  beuius 


lU)        TIIK   CARK   AND    KKKDING    OF   ClIILDJiKX 

to  1)(^  bitter,  avIiou  the  ])r(K'(\-;s  of  (]ii:;estion  lias  ji'one 
furtlior. 

Iloiv  IS  {lie  hiltcr  tasle  avoided  in  parlially  prp- 
fonizcd  milk? 

At  tlie  end  of  ten  or  fifteen  minntcs  tlie  milk  may 
be  ])biccd  in  a  saucepan  and  qnicl<ly  raised  to  boilinii; 
point ;  this  kills  the  ferment,  so  that  the  milk  will 
not  become  bitter  when  warmed  a  second  time.  Or, 
the  milk  may  be  rapidly  cooled  by  placing  the  bottles 
iirst  in  cool  and  then  in  ice  water ;  in  this  way  the 
ferment  is  not  destroyed,  and  the  milk  may  become 
bitter  when  warmed  for  feeding. 

Shoidd  the  leliole  day's  supply  he  peptonized, 
at  once,  or  eacli  bottle  separately  just  before  the 
feeding  f 

Either  plan  may  be  followed.  If  the  former,  it 
is  better  to  raise  the  milk  to  boiling  point  after  pep- 
tonizing; if  the  latter,  it  should  not  be  peptonized 
more  than  ten  minutes,  for  it  will  continue  to  pep- 
tonize while  it  is  being  taken  by  the  child. 

Is  not  the  hitter  taste  of  completely  peptonized 
niillc  a  great  obstacle  to  its  use? 

Xot  in  the  case  of  young  infants;  one  under  four 
or  five  montlis  old  will  usually  take  it  without  any 
o])jection  after  two  or  three  feedings;  but  it  cannot 
often  be  used  for  those  who  are  much  older. 


PEPTONIZKD   MII.K 


117 


II ov  trnich  of  the  peptonizing  powder  should  he 
used.' 

riicre  are  retjiiii-cd  t'tr  <iiic  pint  of  ])laiii  milk, 
live  grains  of  the  extractuin  jiaiicrcatis  aiul  lifteen 
i:i'aiii<  of  l)i('ar])(.»iiate  <if  si.xla.  'I'liis  (|uantitv  is  usu- 
ally jiur  11])  in  a  sinele  Tulie  or  taLlct.  \n  the  fornni- 
las  ]»re\-i(iu>]y  i^iwiu  less  llian  this  ^vill  he  reciiiired  ; 
fnr  the  weaker  fdi'iinilas,  one  half  or  one  third  of 
the  ])0\vdi'r  mentioned  will  he  sutiicient  for  one  pint 
of  food.  For  a  single  feeding:  of  four  (ounces,  one 
may  use  one  eighth  of  a  tulie  with  a  w(nik  formula, 
ur  one  sixth  of  a  tuhe  with  a  stronger  formula. 

II  liul  are  (he  adruniages  of  peptonized  niilk.' 
I'ai'tially  ]K>])tonized  milk  is  useful  for  young' in- 
l'ant<  who  have  great  dilliculty  in  digesting'  the  curd 
<d'  milk.  Sometimes  even  when  diluted  as  already 
dc-ci-ihcd  ;  comiilctcly  ]ieptoniz(Ml  milk,  during  acute 
atiai'k>  of  indigestion. 

/•'//•  lioir  l(i)o/  a  period  niuij  the  use  oj  pep/onized 
null,-    he   eoni lUiieil  ' 

< 'onipl(-i(.l\-  j'cpioin/.cd  milk  ma\'  he  \\<i-(\  for  a 
low-  da\-,  or  at  mo<t  a  tew  week-:  partiallv  pcpto- 
iii/i(!  iMiJk  mav  lie  ii-cd  fdf  I  \\i)  or  ihrcc  month-,  hut 
not  iudotinlicly  :  it  >hMiilil  he  left  (.tf  gradually  hy 
-h' ir'ciiliii:-  the  tiiiio  of  pc|  iti  iii  i/.in^;-.  and  Ic-soniiig  the 
a  iiioiiii  t    I  I    t  !:<■    |,i  iwilei'   iimmI. 


118        THE   C'AKK    AND    KEKDIXG    OF   CIIILDUEX 


FEEDING    DURING   THE   SECOND    YEAR 

lloiv  many  meals  are  required  during  the  second 
year? 

It  is  usually  better  to  continue  five  meals  through- 
out the  second  year.  Some  children  will  sleep  from 
6  V.  Til.  to  G  A.  :\r.  without  waking,  but  unless  there 
is  a  feeding  at  10  p.  m.  children  are  apt  to  wake  very 
early  in  the  morning. 

Should  each  feeding  he  prepared  at  the  time  it 
is  given,  or  all  feedings  at  one  time,  as  during  the 
first  year? 

During  the  second  and  third  years  it  is  better  to 
j)repare  the  milk  for  the  entire  day  at  one  time.  If 
it  is  to  be  modified  by  adding  cream,  water,  etc.,  it  is 
done  as  during  the  first  year. 

Later,  when  only  plain  milk  is  used,  the  quanti- 
ties needed  for  the  different  feedings  should  be  put 
into  one  or  into  two  bottles,  which  then  may  be  pas- 
teurized or  not  as  may  be  necessary.  In  this  way 
the    different    feedings    are   kept   separate,    and   the 


FEEDING    DURIXG    THE    SECOND    YEAR  119 


(lily's  su]>|)]y  (if  milk  is  iicit  distiirlied  cvcrv  time  the 
'■lii](]  is  fed,  as  otlierwise  is  iniavoidablc  The  food 
should  lie  ])re])arod  as  soon  as  ])ossihle  after  the  (hiily 
milk  supply  is  delivered  in  tlie  morning. 


(lire  a  j)ro})('r  diet  jor  an   arcra(jc  licalthy  cJiild 
(if  itrclrc  uiontJis. 

n;30  A.  M.     Milk,  six  to  sovei;  ouiicos ;  diluted  with  hurley  or  oat 
gruel,  two  to  three  ouiiees;  after  the  thirteenth 
nioiith,  taken  from  a  cup. 
9  A.  M.     Orange  juice,  one  tn  two  ounces. 
10  A.M.     Milk,  two  parts:  oatmeal  or  barley  gruel,  one  part; 
from  ten  to  twelve  ounces  in  all  may  be  allowed  ; 
it  sliould  be  given  from  a  cup. 
2  P.M.      lieef  juice,  one  to  twr)  ounces  : 

or,  the  white  of  one  egg,  slightly  cooked  ;  later,  the 

entire  i->j.]s,  ; 
or,  mutton  or  chicken  broth,  four  to  six  ounces. 
."Milk   and   gruel    in   jiroportions  above  given,  four  to 
six  ounces. 
0   r.  M.     Same  as  at  ID  a.  m. 
10  1'.  M.     .Same  as  at   {).'-W  a.  m..  except    that  the  milk   may  be 
Lriven  from  t  he  bidtle. 


Jfnir  lo)t(/   tndi/  llns  sc/icduh'   lie   j OUoH'cd  I 

I'siiallv  until  the  fdiirteenth  or  iiftceuth  inontli. 
.\ftfr  tlii-  time  the  cereals  may  he  o-i\-en  much  thicker 
and    ted    h'liiii   a  spoon. 


l-:0   THE  CARE  AND  FEEDING  OF  CHILDREN 

Mai/  any  other  frail  jaiccs  he  given  at  this 
period? 

Oraiiizo  jniec  is  the  licst ;  next  to  tins  tlio  juice 
of  fresh  ripe  ])eaehes,  red  raspberries  or  strawberries. 
All  these  should  be  strained  very  carefullv  throui2,'li 
muslin  to  make  sure  that  the  child  gets  none  of  the 
])ulp  or  seeds,  either  of  which  may  cause  serious 
disturbance.  Of  the  orange  or  peach  juice,  from 
one  to  fonr  tablespoonfuls  may  be  allowed  at  one 
time;  of  the  others  about  half  the  quantity.  The 
fruit  jnice  is  best  given  one  hour  before  the  second 
feed  ing. 

WJie77  sJiouId  a  child  he  ivcaned  from  its  hottle? 

Most  children  can  and  should  be  tanght  to  take 
their  food  from  the  cup  or  S])Oon  ]\y  the  time  they 
are  thirteen  months  old ;  but  it  is  convenient  to  give 
the  10  r.  M.  feeding  from  the  bottle  during  the 
greater  part  of  the  second  year  (see  page  .")2). 

Give  a  proper  diet  for  an  average  cJiild  from  the 
fourteenth  to  the  eighteenth  montli. 

The  bottle  should  not  be  given  except  at  night. 
Cereals  may  now  form  an  important  part  of  the  dL't 
They  should  be  very  thoroughly  cooked,  usually  for 
three  hours,  and  strained. 


FEEDING    DURING    THE   SECOND    YEAR  lOl 

The  (];iily  scliotlulc  slionkl  be  about  as  follows: 

G.oO  A.  M.     J^Iilk,  warmed,  cii^ht  to  ten  ounee<,  f^iveii  from  a  cup. 
'.)  A.  M.     Fruit  juice,  one  to  three  ounces. 

10  A.  M.     Cereal  :  one.  later  two  or  three.  tal)lesj)o<nifuIs  of  oat- 
meal, hominy  or  wheaten   grits,  cooked   for  at 
least   three   hours;    up(ni   this   from   one   to  two 
ounces  of  thin   cream,  or  milk  and  cream,  with 
plenty  of  salt,  but  without  suyar. 
Crisp  dry  toast,  one  jiiece  ; 
ov,  tnisweeteiied  zwieback; 
or,  one  Huntley  and  Palmer  breakfast  biscuit. 
]\lilk.  warmeil.  six  ti^  eight  ounces,  from  a  cup. 
2   I'.  M.     Beef  juice,   one    to   two   ounces;    and    one   egg   (soft 
bulled,  poai'hed  or  coddled);  and  boiknl  rice,  one 
tablespocinful  : 
or,  broth  (mullou  or  chicken),  four  ounces:  one  or 
two   Huntley   and  Palmer  breakfast   l>iscuits,   or 
zwieba(d< :  and  (if  most  of  the  teeth  ar(>  present; 
rare  scraped  meat,  at  first  one  teaspoonful,  grad- 
ually increasing  to  one  tablespoonful. 
G  r.  M.     Cei'eal  :  two  talih'spoonfuls  of  farina,  cream  of  wheat, 
or  arrowroot,  conked   for  at    least  one  half  hour, 
with  mili<.  plenty  of  salt,  but  without  sugar. 
Milk,  warmed.  ciLdit  to  ten  ounces,  given  fi-om  a  cup. 
10   I'.  M.      .Milk,    warmed,    eight    to    ten    (junces,  which    may    be 
given  fi'om  a  Ijottle. 

(itrc  a  iir()j)f'v  (lid  (or  an  (ivcrcujr  child  from  the 
I  I'jhl'  (  nfli   month   to  the  end  of  the.  second  ycur. 

'J'lie  sauK'  (irdcr  of  meals  as  for  the  niotiths  just 
|irecc(liiiL''  sIhmiM  Ik-  fnllMWcil.  V>>v  iimst  chihlrcii 
liiilk  at  IG  I'.  M.  i,~  dc.-^i  rnlilr.  'I'licre  are  many,  liow- 
e'/er,  wlio  -]e(j)  fegtila I'lv   iVom    C,   i'.    m.   until   G  \.   .\r. 


V22       THE   I'ARK    AND    FKHDTNG    OF   CHILDREN 


Avitlunit  food  ;  for  such  tlio  iiiii'lit  feodincj  should,  of 
oourso,  not  bo  insisted  n])on. 

Tlic  daily  schedule  should  be  about  as  follows: 

6.30  A.  M.     ^lilk,  wurinod.  ten  to  twelve  ouin'os.  given  from  cup. 

9  A.  M.     Fruit  juice,  two  to  tlii'ee  ounces. 

10  A.M.     Cereals:  similar  to  those  given  from  the  fourteeiitli 

to    the    eighteenth     month ;    they    need    not    be 

strained   although   they  should  be   cooked   and 

served  in  the  same  way. 

Crisp  dry  bread,  zwieback,  or  Huntley  and  Palmer 

biscuits,  without  butter. 
Milk,  warmed,  one  cup, 
2  p.  M.     Beef  juice  and  one  egg; 

or,   broth   and   meat;    care   being  taken   that    the 
meat  is  always  rare  and  scraped  or  very  finely 
divided  ;    beefsteak,  mutton  chop,  or  roast  beef 
may  be  given. 
Very  stale  bread,  or  two  pieces  of  zwieback. 
Prune  pulp  or  baked  apple,  one  to  two  tablespoonfuls 
Water;  no  milk. 
6  p.  M.     Cereal:  farina,  cream  of  wheat,  or  arrowroot,  cooked 
for  at  least  one  half  hour,  with  milk,  plenty  of 
salt,  Vjut  without  sugar, 
or,  milk  toast  or  stale  bread  and  milk. 
10  P.  M.     If  required,  ten  to  twelve  ounces  of  plain  milk. 

What  fruits  may  he  given  at  tJris  period? 

If  the  child  has  a  feeble  digestion,  only  the  fruit 
juices  ])reviously  allowed  ;  strong  children  may  have 
in  addition  prune  ]iul]\  baked  apple,  and  apple- 
sauce. The  prune  pulp  is  prepared  by  stewing  the 
dried  prunes  without  sugar  until  they  are  very  soft, 


FEEDING   DURING    THE   THIRD    YEAR  liO 


and  reiiiovinfr  all  the  skin  bv  pntting  the  fruit 
through  a  strainer;  of  this  from  one  to  two  table- 
spoonfuls  may  be  given  at  one  time.  The  baked 
ap{)le  should  be  given  without  eream,  and  the  apple- 
sauce should  have  very  little  sugar. 

Hon-  and  vlien  should  ivafer  he  gircJi? 

Throughout  the  second  year  water  shonld  be 
given  frwdy  between  the  feedings,  especially  in  warm 
weather :  from  one  to  three  ounces  may  be  given  at 
one  time,  either  froiu  a  spoon,  a  glass,  or  a  bottle. 
1die  water  should  be  boiled  daily  and  then  cooled. 
It  should  not  be  allowed  to  stand  in  the  room,  but 
fresh  water  sluiuld  be  ])ut  into  the  bottle  eacli  time. 

FEEDINCJ    DURING   THE    THIRD    YEAR 

WJiaf  c/iatifir's  may  he  made  in  the  diet  during 
the  third   ijearf 

The  night  feeding  at  10  \\  y\.  should  be  omitted. 
A  ui'eatcr  quantity  of  solid  food  uiay  be  allowed, 
particularly  at  the  mid-day  meal.  Tt  is  not  advisabh; 
to  bcu'iu  potato  aii<l  other  vei^etables  until  lliis  age  is 
reached.  'ihi'ee  reguhir  meals  shouM  be  given  and 
milk  m!ic<'  b(--ide-,  eitliei'  l.elweeu  tlie  bi'eakt'a>t  and 
dimier  or  dinner  and  supper,  whichever  is  the  longer 
interval.  Water  should  he  hIIowimI  frctdy  between 
meals. 


ILM        THE   CAKE   AND    FEEDING    OF   CHILDREN 


U7/(//  ii-ouhl  be  a  proper  scliedulc  for  an  average 
cltild  duri)i(/  ilie  third  year? 

7.0O  A.M.     Cereal:    cooked    (preferably    over    iiiu^lit)    for    three 
liours.  allhouixli  a  soinewhal    larger  variety  iiuiy 
be  given  tiian  during  tlie  second  year;  given  as 
before  with   milk  or  thin  cream,  salt,  but  very 
little  sugar. 
Warm  milk,  one  glass. 
A  soft  egg,  poaciied,  boiled  or  coddled. 
Bread,  very  stale  or  dry,  one  slice,  witli  butter. 
10  A.  M.     Warm  milk,  one  cup,  with  a  cracker  or  piece  of  very 
stale  bread  and  butter. 
2  p.  M.     Soup,  four  ounces  ; 

or,  beef  juice,  two  ounces. 
Meat :  chop,  steak,  roast  beef  or  lamb  or  cliicken. 
A  baked  white  potato; 

or,  boiled  rice. 

Green  vegetable :  asparagus  tips,  string  beans,  peas. 

siiinacli ;  all  to  be  cooked  until  very  soft,  and 

mashed,  or  preferably   put   through  a  sieve  ;  at 

first,  one  or  two  teaspoonfuls. 

Dessert:  cooked  fruit — baked  or  stewed  apple,  stewed 

prunes. 
Water;  no  milk. 
6  p.  M.     Cereal:  farina,  cream  of  wheat,  or  arrowroot,  cooked 
for  at  least  one  half  liour,  with  plenty  of  salt,  but 
witiioul  sugar ; 
or.  milk  toast : 
or,  bread  and  milk  : 

or,  stale  or  dry  bread   and   butter  and  a  glass  (  f 
milk. 


PART   III 
THE    DIET    OF    OLDEIl    CIIILDREX 


Ill 

THE   DIET   OF    OLDER   CHILDREN 

(FOURTH    TO   TENTH    YEAR) 

Tlirouii'lioiit  this  period  the  lar^rest  meal  should 
alwavs  be  in  the  middle  of  tlie  day.  and  a  liglit  sup- 
})er  jiiven,  verv  much  like  tliat  deserihed  for  the  third 
year.  I)iirin<r  the  first  lialf  of  this  ])eriod,  milk  may 
Ik'  allowed  once  either  between  lireakfast  and  dinner 
or  dinner  and  ?up])er;  no  other  eatinii;  between  meals 
shoidd  be  {)ermitte(b  but  water  should  be  allowed 
freely. 

Mir.K     A  XI)    CKKAAf 

W  lull  part  of  the  dicl  sliouhl  uiilk  form  during 
rh  I  Id  hood  7 

It  should  form  a  very  important  j)art  up  to  the 
tenth  year:  imthinii'  ean  take  its  place.  There;  ar(^ 
(•nin[iarati\-ely  few  childi-en  who  cannot  take  and 
digest  milk   if  it   is   pi-opn-ly   fed. 

II  // //   IS  inillr  so  (id nnilo'ji'oiis .■' 

l!cc;iii<e  no  fund  that  \vc  [)(i-se,~-  has  so  hiirb  a 
nut  I'll  i\-c   \-alue  as  iidlk.    t'i>r  tlic  amount  of   work  re- 

127 


us       Till-:  CARE  AND  FEEDING  OF  CHILDREN 


quired  of  the  org-ans  of  diuestion.      It  is,  therefore, 
peculiarly  a(-Iaj)ted  to  the  diet  of  tlic  child. 

What  arc  (he  essential  poiiiis  in  ilie  use  of  milk? 

It  sliould  be  clean  and  fresh,  but  not  too  rich.  Tt 
is  a  mistake  to  select  for  any  children  the  rich  milk 
of  a  Jersey  herd  and  use  it  as  thoug'h  it  were  an 
ordinary  milk,  i'or  children  ^vho  have  difficulty  in 
digesting  milk,  it  should  be  somewhat  diluted,  i.  e., 
one  part  of  water  to  four  parts  of  milk,  or  salt  or 
bicarbonate  of  soda  should  ])e  added.  It  is  also  im- 
])ortant  not  to  give  milk  at  meals  wdien  fruits,  espe- 
cially sour  fruits,  are  allowed. 

IIoiv  mucli  milk-  may  advaniageousJij  he  given? 

The  average  child  with  good  digestion  should 
take  from  one  and  one  half  ])ints  to  one  quart  of 
milk  daily,  tliis  including  not  oidy  what  the  child 
drinks  but  what  is  served  upon  cereals  and  in  other 
ways.  It  is  seldom  wise  to  allow  a  child  to  take  as 
much  as  two  quarts  daily,  as  a  more  mixed  diet  for 
most  children  is  better. 

To  wltat  extent  may  cream  he  used? 

Older  children  do  not  require  so  large  a  propor- 
tion of  fat  in  their  food  as  do  infants,  and  the  use 
of  cream,  especially  very  rich  cream,  often  results  in 
disturbances  of  digestion.  The  use  of  too  much  or 
too   rich    cream    is    a    common   cause   of   the   coated 


THE   DIET   OF   OLDER   CHILDREN  129 

tdiig-ue,  foul  breath  and  pale  gray  stools,  often  called 
"  biliousness." 

Is  not  cream  useful  i}i  overcoming  the  constipa- 
tion of  clnldren  ? 

With  infants  it  is  vahiable  to  a  certain  point,  bnt 
with  older  children  only  to  a  limited  degree,  and  if 
such  symptoms  as  those  above  described  are  present, 
t-reani  sh<juld  not  be  given. 

EGGS 

7'o  u-iint  extent  may  cygs  he  used  in  the  diet  of 
this  period  ' 

They  form  a  most  valuable  food.  It  is  essential 
that  th(-y  .--lionld  l^e  fresh  and  only  slightly  cooked, 
xil'r  Ixiiied,  ])()aclied  r»r  coddkMl  ;  fried  (\gu's  sliould 
nc\'cr  lie  a-i\-en  and  all  omelets  are  objectionable. 

WhirJi    IS   more    dujesldjle^    the    adute    or   yolk   of 

thr    e,,,,^ 

I'or  the  ureat  Tiiajority  of  childi'cn^  the  white  (d' 
the  v^^<j:,  '1  liis  forms  one  of  the  mo-t  digostil)le  ])ro- 
toiii-  we  po.-,>c>.-;.  jiiid  cjiii  be  used,  even  in  the  latter 
pai't    of  the  tir>t    y<'ai',   villi  ad\'autagc. 

Ix  il  hot  true  that  c'pjs  ojten  cause  "  Ij/tious- 
t,>ss  ••/ 

X'ory   s(-ldom,    if   fed    as    ;diove    advised.       This   is. 
ail  <TJ   pro judicc  but   ha-  lilllo  ba-is  in  fact. 
9 


VM       THE   CAKH   AND    FKKDINt;    OK   CIllLDIlEX 


lloir  of/en  }uai/  ('(jgs  he  (jircn? 

^lost  cliildren  from  four  to  ten  years  old  will 
take  one  ejiii;  for  breakfast  and  another  for  supper 
for  an  iudetinile  ])eriod  with  relish  and  benefit. 
There  are,  however,  some  few  who  have  a  peculiar 
idiosynerasv  as  regards  eggs  and  cannot  take  them 
at  all. 

MEAT    AXl)    FISH 

What  meats  may  he  given  to  young  cliildren? 

The  best  are  l)eefsteak,  mutton-chop,  roast  beef, 
roast  lamb,  broiled  chicken  and  certain  delicate  fish, 
such  as  shad  or  bass. 

^^■llat  are  the  important  points  to  be  considered 
in  givi7ig  meat  to  cliildren? 

Most  meats  should  be  rare  and  either  scraped  or 
very  finely  divided,  as  no  child  can  be  trusted  to 
chew  meat  properly.  ]\reats  are  best  broiled  or 
roasted,  but  should  not  be  fried. 

flow  often  should  meat  he  given? 

At  this  period,  only  once  a  day,  at  the  mid-day 
meal. 

7s  not  the  excessive  nervousness  of  many  modern 
children  due  to  the  giving  of  meat,  or  at  least  aggra- 
vated hy  its  use? 

There  is  little  ground  for  such  a  belief,  unless 
an   excessive   amount   of  meat  is   o-iven.      Certainlv 


'I'HK    lUHT   OF   OLDER    CHILDREN  131 


(.'Uttiiiir  off  meat   from  the   diet   of  nervous  children 
S(d(l(>m  ]ti'(»(liices  any  striking*  benefit. 

Wliaf  nicfits  sJiouhl  he  forJjiddcn  to  young  cJiil- 
dniif 

Uam,  bacon.  <aiisag'e,  jxjrk,  liver,  kidnev,  game 
and  all  dried  and  salted  meats,  also  cod,  mackerel 
and  lialibiit :  all  of  these  are  best  withheld  until  the 
chihl  has  ])asseil  the  tentli  year. 

Are  ho(  f/rarii's  Ixncficial  and  nutriiious? 

The  beef  juice,  or  so-calle(l  "  ])latter  gravy."  from 
a  roast  is  exceedingly  nutritions  and  desirable,  but 
many  of  the  tlnckened  gravies  are  much  less  diges- 
tible and  are  too  often  given  in  excess;  only  a  small 
(piantity  slioidd  be  allowed.  They  shoidd  not  form 
an  imjtortanf   ])ai't  of  the  meal. 

\ki;ktahlks 

What   i-rgr/ahlcs  iiiai/  he   //nvJ  al  iJns  jx'nod^ 
White  ])otato('s  may  be  given  first.     Tluvse  should 
]ir<-ferably  be  baked  or  boihul  and  maslied,  but  never 
fried.       Tlicy    should    lie    sci've(l    willi    beef    juice    or 
Willi  ci'(-am  i-allier  llian  with  butter. 

<  )f  the  ureeii  \-ei;'eIables.  the  best  are  pea-,  spinach, 
a-paraa'iis  tips,  slriiia'  beans,  stewed  celei'v,  young 
beet,-,  or  carrot-,  and  -(pia-h.  Ilaked  sweet  potato, 
tMi'uips.  boiled  onion-  and  canlitlowei',  all  well  cooked. 


i:i-2       THE   CAKH   AND    FKKDING    OF   CIIILDREX 

niav  1)0  aivoii  after  tlie  sixth  or  soventli  year  in  mod- 
erate anioiiiit. 

'Iho  ])rinei])al  troii])le  in  the  digt^stion  of  ve<^e- 
tahlcs  is  duo  to  iin])erfcc't  cooking.  ]t  is,  in  fact, 
ahnost  inipossihlo  to  cook  thcni  too  much;  thoy  should 
also  he  very  finely  nuishod.  They  form  a  valuahlo 
addition  to  the  diet  after  three  years,  althoui^-h  the 
amount  at  first  given  should  be  small,  one  or  two 
teaspoonfuls.  They  greatly  aid  in  securing  regu- 
larity of  the  bowels.  Because  small  particles  are 
seen  in  the  stools,  it  is  not  to  be  inferred  that  they 
are  causing  disturbance  and  should,  therefore,  he 
stopped,  but  only  that  they  should  be  more  thor- 
oughly cooked  and  more  finely  divided  before  being 
given. 

/x  It  safe  to  use  canned  vefjetahles  for  cliil- 
drrn  ? 

]\[any  of  tlie  best  brands  of  canned  vegetables  are 
quite  safe  and  some,  such  as  peas  and  asparagus, 
can  be  used  with  advantage.  They  are  frequently 
better  than  stale  green  vegetables  often  sold  in  the 
markets. 

What  rcgetahles  should  not  he  given  to  young 
children  ? 

Xone  of  those  which  are  eaten  raw,  such  as 
celery,  radishes,  onions,  cucumbers,  tomatoes  or  let- 


THE   DIET   OF   OLDl^R   C'lIILDREX  133 


luce.  ("(^Ttaiii  others,  even  Avlien  well  cooked,  should 
lint  1k'  allowed:  as  e<»ru,  lima  beans,  cabbaii'e,  egg 
jilaiit.  Xone  of  these  should  be  given  until  a  child 
lias  ])assed  the  age  of  ten  years. 

.1/7'   rrrjclahh'  saJdds  to  he  gircn? 

As  a  rule  salads  of  all  kinds  should  be  omitted 
until  a  child  has  ])assed  the  tenth  vear.  Salads  are 
difhcult  to  dig(\st  and  a  cause  of  nnicli  disturbance 
in  children  of  all  aaes. 


■   CKIJKAT.S 

Wild/  arc  llw  nidsl  unporlaiii  points  in  srlrrling 
and  jircpavuuj  ccrrals .■' 

The  im])<)rtant  things  are  that  they  are  ])ro])erly 
(•(Miked  and  not  used  in  excess.  ddie  ready-to-serve 
cereals  -liquid  never  be  chosen  for  children,  nor 
>lioid(!  a  child,  because  he  is  fond  of  cereals,  he. 
allowed  to  make  his  entii-e  meal  of  them,  taking  two 
oi-  three  sancei'fuls  at  a   fee(|ing. 

Many  ot"  the  ])artially  codked  j)i"e])arat  ions  of 
oatmeal  and  wheat  ai'c  excellent,  but  should  be  cooked 
toi'  a  milch  longer  time  than  is  stated  ujHin  the  pack- 
age, ii<iiall\-  three  or  t'oiir  time<  as  loiii;'.  Pigesti- 
bilitv  i-  chiefly  ;i  matter  <<i'  proper  eorikin^-.  Most  of 
the  iiniiii-,-  oatmeal,  hominy,  rice,  wheiileu  li'rits, — 
rcMiiii-e  ;it  lea-t  thi'ce  lioiir>'  ciM.kim;  in  a  double  boiler 


134        Till':   CAKK   AND    FEEDING   OF   CHILDREN 


in  order  to  1k'  easily  (lit!;este(l.  The  pre])are(l  flours, 
— corn  starch,  arrowroot,  barley, — should  be  cooked 
at  least  twenty  miiiiites.  I  know^  of  no  preparation 
in  the  modern  market  which  requires  no  cooking, 
which  is  to  \)e  recommended  for  children. 

How  arc  cereals  io  he  given? 

I'snally  with  milk  or  a  mixture  of  milk  and 
cream  ;  always  with  an  abundance  of  salt  and  with 
very  little  or  no  sugar,  one  half  teaspoouful  on  a 
sancerful  of  cereal  should  be  the  limit. 

Cereals  shonld  not  be  served  with  syrups  or  but- 
ter and  suirar. 


BEOTHS    AXD    SOUPS 

What  hrotJis  and  soups  arc  to  he  recommended? 

Meat  broths  are  generally  to  be  preferred  to 
vegetable  broths,- — mutton  or  chicken  being  usually 
most  liked  by  children.  Xearly  all  plain  broths  may 
be  given.  Those  thickened  with  rice,  barley  or  corn 
starch  form  a  useful  variety,  especially  with  the 
addition  of  milk. 

Vegetable  purees  of  peas,  spinach,  celery  or 
asparagus  may  be  used  for  children  over  seven  years 
old.  Torjiato  soup  should  not  be  given  to  young 
children. 


THE    DIET   OE   OLDER   nilLDREX 


135 


KKKA!),     CKACKEHS    AXD    CAKKS 

Wlinf  forms  of  hrcadshiffs  arc  best  suited  to 
'i/oioi'j  children.' 

yresli  bread  slionld  nor  l»e  iiivoii,  l)ut  stale  bread 
cut  til  in  and  freshly  drii^l  in  the  oven  nntil  it  is 
ci-i.-p  is  very  nseful,  also  zwieljack,  the  nnsweetened 
lieing  ])referred.  Oatmeal,  u'rahani  or  i>-luten  crack- 
ers, and  the  Ilnntley  and  I^alnier  l)roakfast  l)iscnits, 
stale  rolls,  or  corn  liread  \vhich  has  been  split  and 
Toasted  or  dried  til!  crisp,  form  a  sutHcient  variety 
for  ]iiosr  (diildren. 

^y]lal  hrcadsiiiffs  slioiild  he  forbidden^ 
All  hot  br(>ads,  all  fresh  rolls,  all  l)nckwheat  and 
other  a'l'iddle  cakes,  all  fresh  sweet  cakes,  especially 
tho.-e  covered  with  icinu'  ami  those  containinf^;  dried 
fruits.  A  stale  lady-iinuci'  or  pi(H-e  of  sponii;e  cake 
i-  about  as  far  in  the  matter  of  cakes  as  it  is  wise  to 
ao  with  children  uj)  to  seven  or  eiiiht  years  old. 


1)KSS  KIM'S 

11  lial  desserts  iiinij  tic  f/iren  to  yminq  elu'Jdrcri'' 
^listakes   are  moi'c  often   ina<le  here  than   in   any 
other   jiart    of   the   cliihTs    diet.       I'j)    to   six   or   seven 
year-,   only   junket,   phiin    rice   ])uddini;'  without    rai- 


i;]6        TllK   VAUE   AND    FEEDING    OF   CHILDREN 

sins,  ])];nii  cushird  :m<l,  ikU  more  tlian  once  a  "week, 
a  small   aiiKMiiit  of  ice  cream. 

Wliat  sJioidd  hr  espccinlhj  fnrh'uhlenf 

All  pies,   tarts  and  pastrv  of  everv   description, 

jam,   syni])s  and   })reser\-e(l   frnits;   nuts,   candy  and 

dried  frnits. 

Docs  "  a  Jiftle  "  do  amj  Jiarrn? 

Yes,  in  that  it  develops  a  taste  for  this  sort  of 
food,  after  which  ])lainer  food  is  taken  with  less 
relish.  Ei^sides  the  "  little  "  is  very  apt  soon  to  be- 
come a  g:ood  deal. 

Docs  not  fhc  cliihl's  inslincfin'  craving  for  sweets 
indicate  Jiis  need  of  tlieui.' 

That  a  child  likes  or  craves  sweets  is  the  nsnal 
excuse  of  an  indnlg'ent  ]iarent.  Every  child  likes 
his  own  way,  hnt  that  is  no  reason  why  he  should  not 
he  trained  to  obedience  and  self-contr(d ;  a  child's 
fondness  for  sweets  can  hardly  be  considered  a  nor- 
mal instinct.  As  a  matter  of  fact,  supported  by 
everyday  experience,  no  causes  are  productive  of 
more  disorders  of  diae^tion  than  the  free  indul2:encc 
in  desserts  and  sweets  bv  younc-  children.  It  is  a  con- 
stantly increasino-  tendency,  nr)t  easily  controlled  as 
a  cliild  crows  older;  and  in  early  childhood,  the  only 
safe  rule  is  to  aive  none  at  all. 


THE   DIET    OF   OLDER   CHILDREN  137 

FKUITS 

Are  fruil-'i  an  cs.<r)iii(iJ  or  important  part  of  tlir 

'lirf.' 

Tliov  are  a  vcrv  iiiiportant  part  and  should  be 
hcu'un  in  infancy.  They  are  partieuhirly  nseful  for 
rhe  efFecT  rliey  liave  n])on  the  l)o\vels.  ]t  is  iin])ortant 
Uiat  tliey  should  he  s(>]e(*ted  \vith  care  and  g'iven  with 
much  discretion,  esp'cially  in  cities.  In  the  country 
where  fruit  is  ahsolutely  fresh,  a  somewhat  greater 
la'itude  nuiy  he  allowed  than  is  aiven  helow. 

W'liaf  fruit-^  niaij  safclij  he  rjirm  to  cJtildren  ap 
to  firr   i/r'irs  otd? 

As  a  acnei'al  rule,  oidy  cooked  fruits  and  the 
juires  of  fi-e-h  fruits. 

What  fruit  jairrf;  tnaij   ]/c   used? 

That  from  sweet  <(ranu'es  is  the  hest,  hut  the  fresh 
juice  of  orape  fruit.  ]>eaches,  strawberries  and  rasj)- 
lieri'ie-  ma\'  al-o  Ik*  used. 

U  ii/if  stcired  fruits  luai/   tje   fjireti! 
Stewed    oi-   linked    apples,    prune-,    pears,    ])eaches 
:iud    ajirieot-^. 

What  mil'  fniils  arc  In  t,r  jxtrt leulart if  aroidi'd 
ir it h     i/Dii III/    ell  ddri'U  ' 

riie  pidp  of  (ii';ini;es  ,,v  ui-;ipe  fiuiit,  also  cherries, 
hi-ri'ie-.   li;inaiia~  and   pinea])ple. 


i;?8        THE   CARE   AND    FEEDIXCl    OF   CIIII.DIIEN 

\\  hai  prccaii/ i(>n><  sJiouh]  he  oiipliasizcd  mjard- 
liKj  the  iisi'  of  f rails.'' 

That  tlu'v  sliould  l»o  used  witli  o;rcater  care  in 
li(>r  ^vc'atlu>l•  aiul  witli  cliildrc'ii  who  are  ])r()iU'  To 
attacks  of  intostiiial   iiuliiicstioii. 

WJiai  syntpfoiiis  liulieatc  ihat  fruils  should  he 
a  raided  / 

A  tondoncv  to  looseness  of  tlie  howels  with  the 
(liseliarge  of  nmciis,  or  frequent  attacks  of  abdominal 
])ain  or  stoniacli  ache. 

Is  there  any  special  choice  of  meals  at  which  fruit 
slioidd  he  given? 

The  fruit  juice  oiven  earlv  in  the  morning,  upon 
an  empty  stomach,  works  more  actively  npon  the 
bowels  than  if  it  is  given  later  in  the  day. 

It  is  not,  as  a  rule,  wise  to  give  cream  or  milk 
with  sour  fruits.  Usually  the  fruit  is  best  given  at 
the  mid-day  meal,  as  a  dessert,  at  a  time  when  no 
milk  is  taken.  It  is  in  all  cases  important  that  the 
(piantity  of  fruit  should  l)e  moderate. 

^yhat  hesides  water  and  milk  should  a  child  he 
allou:ed  to  drinh  and  vhat  sltould  he  forhidden? 

Tea,  coffee,  wine,  beer  and  cider  in  all  quantities 
and  in  all  forms  should  be  f(;»rbidden  to  young  chil- 
dren below  pul)erty.  Cocoa  Avhich  is  made  very 
weak,  i.  e.,  almost  all  milk,  is  often  useful  as  a  hot 


INDIGESTION    IN    OLDER   CHILDREN  139 


•  li'iuk.  L('in(»ii;i(l(\  soda-watoi-,  etc.,  sliould  if  pos- 
>ilile  1)0  deferred  muil  the  tenth  year.  A  free  iri- 
duliiciiee  in  thinas  i)f  this  kind  should  never  be  per- 
mitted with  chiMren  uf  seven  or  eiaht  vcars. 


ini)igp:stiox  ix  older  childrex 

W/ial  arc  (hf  iJifj event  trai/s  in  trhicJi  indigestion 
.slitjirs  itscjf  in  rliilih'rn  .' 

V]v<\,  in  acute  di.-turhanees  which  last  for  a  few 
(hiys  only;  and,  secondly,  in  chronic  disturbances 
\\'liich  niav  contiuue  for  weeks  or   iiii>nths. 

Which  (if  the  t ii-()  junns  tif  in(Ii(/esfion  is  more 
liL-i'ti/  to  nn/iair  srviijiisl ij  the  health    of  the  child' 

( 'lirouic  indiue-I  ii  111  :  foi-  :-iiice  the  cause  is  not 
rccooiiizcil  it  ottcii  li'X'^  ou  for  iiioiiths  and  even 
\far>  Mncliecke<l. 

What   arc  the  st/m  [jtonts  of  acute    ind  Kjestion  ! 
I  lic-c  ai'c  iaiiuliar  and   ca-ih'   I'ecouiii/.ed.       TIm".' 
.ii'i'   \otiiit  inii'.    pain.    nndii:c-tcd    iiioveiiietils    t'roni    tlie 
li'iu*  Is.  often    fe\-cr  and   ciiii^iderahle   prostration. 

Siidi  attai'k-  arc  ii-nall\'  traci'ahle  to  ihclr  proper 
i-;iii~c.    llic    r('nio\:i]    lit'    which    is    t'oHnweil    h\     proni[)t 

Vcri,\i-r\  , 


140        TllH   CAKK    AND   FHKDING   OF   CHILDKKN 

U  hat  arc  /lie  common  caiiscs  of  acute  ind't- 
(jcslion  ■ 

This  is  frcqiu'iitlv  diu'  t<»  ovcroatiiiix,  to  indiil- 
iioiK'o  in  some  special  article  of  iin])ro])er  food,  en'  to 
oatiiiii'  li(>artil_v  wlicii  overtired.  Acute  indigestion 
often  marks  the  beginning-  of  some  acute  general 
illness. 

How  should  acute  iudujestion  he  managed? 

One  should  l)ear  in  mind  that  for  the  time  being 
the  digestive  organs  luive  stop])ed  work  altogether. 
The  im})ortant  thing,  therefore,  is  to  clear  out  froui 
the  intestines  all  undigested  food  by  some  active 
cathartic,  such  as  castor  oil.  The  stomach  has  usu- 
ally emptied  itself  by  vomiting.  All  food  should  be 
stopped  for  from  twelve  to  thirty-six  hours,  accord- 
ing to  the  severity  of  the  attack,  only  water  being 
given. 

^•1/  the  end  of  this  time  is  it  safe  to  hegin  with 
the  former  diet? 

Xo ;  for  such  a  procedure  is  almost  certain  to 
cause  another  attack  of  indigestion.  At  first  oidy 
broth,  thin  gruel,  very  greatly  diluted  milk,  or  whey 
should  be  given.  The  diet  may  be  very  slowly  but 
gradually  increased  as  the  child's  ajjjx'tite  and  diges- 
tion ini]u"ove,  but  in  most  cases  a  week  or  ten  days 
should  ela})se  before  the  full  diet  is  resumed. 


IXDIGESTIOX    IX   OLDER   CHILDREN  141 

What  are   the   symptoms  of  chronic   indigestion? 

Tliese,  although  familiar,  are  not  so  easily  dis- 
tinguished and  are  very  often  attributed  to  the  wrong 
cause.  There  are  usually  general  syniptouis  such  as 
iudisjiosition,  disturbed  bleej),  grinding  of  the  teeth, 
fi'ctfulness,  languor,  loss  of  weight  and  anu>niia. 
There  are  besides  local  symptoms:  flatulenee,  abdcMu- 
inal  ])aiu,  abdominal  distention,  constipation,  oi" 
looseness  of  the  bowels  with  mucus  in  the  stools,  foul 
breath,  coated  tongue,  loss  of  appetite,  or  an  ab- 
normal, ca])ricious  appetite.  Such  symptoms  are 
<'ften  wrongly  ascrilx'd  to  intestinal  worms. 

Wliat    arc    the    common    causes   of   chronic    indi- 

r/rsli(m  / 

This  is  .generally  the  result  of  a  bad  system  of 
tce(!i]ig,  citlier  the  ])rolonge(l  use  of  improper  food 
or  oi   iiii]u'()])er  methods  of  feeding. 

l"..\am])les  of  bad  methods  of  fecnling  are,  coaxing 
oi'  torciiig  to  eat,  I'apid  (>atiug  with  insuflicient  mas- 
tif.-ition,  eating  between  meals,  allowing  a  (diild  to 
Invc  his  own  way  in  selecting  his  food,  as  when  ho 
\\vc-  hir^^cly  upon  a  single  article  of  diet.  'Idlings  to 
iio  coii-idcrcd  under  the  head  of  inipro})er  fo<»(l  ar(\ 
iiiduliicnce  in  sweet-,  (h-.-sei'ts,  etc.,  the  use  of  ini])(M"- 
lectly  cool^ed  foods,  especially  cej-eals  an<l  vegetables, 
and  ot'  I'aw  <ir  >fal<'  fruit-. 


142        THE   ("AUE   AND    FHKDING    OF   CIIILDKKX 

Is  If  not  (rue  llidl  a  dirt  or  a  spcrinl  articla 
of  food  which  docs  not  inah-c  a  child  ill  is  proof 
that  such  a  diet  or  such,  a  food  is  proper  for  a 
child.' 

By  no  moans;  with  many  people  the  only  guide; 
in  feiHlino;  children  is  that  the  article  in  question  did 
not  make  the  children  sick,  therefore  it  is  allowable. 
This  is  a  very  bad  princi])le.  A  better  one  is  to  adopt 
such  a  diet  as  will  nonrish  the  child's  body  with  the 
least  possible  tax  upon  his  digestive  organs ;  in  other 
Avords,  to  exclude  articles  Avhich  experience  ha?:  shown 
to  be  injurious  to  most  children. 

7/ou'  should  chronic  indigestion  he  managed? 

This  is  a  much  more  difhcult  matter  than  the 
treatment  of  acute  indigestion,  for,  as  it  is  usually 
the  result  of  the  prolonged  use  of  improper  fVxKl  or 
of  an  improper  method  of  feeding,  a  cure  can  V)e 
accomplished  only  l)y  a  discovery  and  removal  of 
the  cause. 

Is  chronic  indigestion  curable? 

In  the  vast  majority  of  cases  it  is  so,  but  only 
"by  faithfully  observing  for  a  long  period  the  rules 
for  simple  feeding  laid  down  elsewhere.  One  of  the 
greatest  difficulties  in  the  way  of  recovery  is  that 
parents    and   nurses    are    unwilling   to    folloAV   a    re- 


(.i:n]-:ual  ijulks  tu  p.k  ursehved  in  eeeding   143 

.'irieted  diet  loiiii'  ciiniioli  \o  secure  a  complete  cure, 
or  to  cliaiiire  radically  their  methods  of  feediiiir, 
hut  exjiect  the  child  to  recover  by  simply  taking 
medicine. 

Fof  h())r  h))i<i  a  period  is  it  necessary  to  continue 
rmj  rorcfiti  fceiltnij.' 

In  any  case  it  must  be  done  for  several  months: 
wirji  most  childi-en  for  two  or  three  years;  with  some, 
f lii'ouizhout  childhood,  for  with  them  tlie  slightest 
<lr\i;^tion  from  established  rules  is  stire  to  provoke  a 
relapse. 

Ix  not  niedifnic  }ispj)d? 

If  is  un(ioubte<lly  of  assistance  for  the  relief  of 
>oiiie  symptoms,  but  the  esH'ntial  thing  is  proper 
feeding,  without  which  nothing  permanent  can  be 
aecom])lished. 


(iKXKlLVL   IIULKS   To    P,K   OBSEliVED    IN 
FEKDIXC 

niiij    h;d'its    of    eatiui:'    ;ire    I'eadily    acquired    but 
<]itlieiib   \(>  break. 

poling   cliihlren    -houM    not    lie    allo\ve(]    to    [»biy 


144        THE   CAKE    AND   FEEDlNli    ()E   CHILDREN 

with  tlieir  food,  nor  sliould  tlio  lial)it  he  fornuMl  of 
niinisiui^  or  divertiiii>;  tliem  Avliile  eatiiii;',  because  Ly 
tliese  means  more  food  is  taken. 

Older  children  should  n(»t  he  permitted  to  make 
an  entire  meal  of  one  thiui:-,  no  matter  how  proj)er 
this  nuiy  he. 

Children  who  are  allowed  to  have  their  own 
way  in  nuitters  of  eating'  are  very  likely  to  he 
badly  trained  in  other  respects;  while  those  who  have 
been  properly  trained  in  matters  of  eatiuii;  can  usu- 
ally he  easily  trained  to  do  anything  else  that  is 
important. 

Learning  to  eat  projicr  things  in  a  proper  way 
forms  therefore  a  large  part  of  a  child's  early  edu- 
cation, hf  careful  training  in  these  nuitters  is  heguu. 
at  the  outset  and  continued,  the  results  will  well  re- 
pay the  time  and  effort  required. 

Whether  the  child  feeds  himself  or  is  fe<l  by  the 
nurse,  the  following  rules  should  be  observed : 

1.  Food  at  regular  hours  only;  nothing  between 
meals. 

•2.  Plenty  of  time  sliould  be  taken.  On  no  ac- 
count should  the  child  bolt  his  food. 

o.  The  child  must  be  taught  to  chew  his  food. 
Yet  no  matter  how  much  pains  are  taken  in  this 
respect,  mastication  is  very  imperfectly  done  by  all 
children;  hence  up  to  the  seventh  year  at  least,  all 


GENERAL  RULES  TO  BE  OBSERVED  IN  FEEDING   145 

meats  should  be  very  finely  cut,  all  vegetables  mashed 
to  a  pulp,  and  all  grains  cooked  very  soft. 

4.  Children  should  not  be  continually  urged  to 
eat  if  they  are  disinclined  to  do  so  at  their  regular 
hours  of  feeding,  or  if  the  appetite  is  habitually 
poor,  and  under  no  circumstances  should  a  child  be 
forced  to  eat. 

5.  Indigestible  food  should  never  be  given  to 
tempt  the  appetite  ^vhen  the  ordinary  simple  food  is 
refused ;  food  should  not  be  allowed  between  meals 
because  it  is  refused  at  meal-time. 

G.  One  serious  objection  to  allowing  young  chil- 
dren highly  seasoned  food,  entrees,  jellies,  pastry, 
sweets,  etc.,  even  in  such  small  amounts  as  not  to 
upset  the  digestion,  is  that  children  thus  indulged 
soon  lose  appetite  for  the  simple  food  which  pre- 
viously was  taken  with  relish. 

7.  If  there  is  any  im])ortant  article  of  a  simple 
diet  sucli  as  milk,  meat,  cereals,  or  vegetal)les,  which 
a  child  habitually  refuses,  this  should  always  be 
given  iii'sr  at  the  meal  and  other  food  withheld 
until  it  is  disposed  of.  Children  so  readily  form 
haliits  of  eating  only  certain  things  and  refusing 
(ttliors  that  ^n(■ll  an  inrdination  should  be  checked 
eaidy. 

^.    If   an    infant    refuses    its   food    altogether,    or 

takfs  less  than  usual,  the  food  shouM  be  examined 
10 


146       THE  CARE  AND   FEEDING   OP   CHILDREN 

to  see  if  this  is  right.  Then  the  inouth  should  bo 
inspected  to  see  if  it  is  sore.  If  neither  of  these 
things  is  the  canse,  the  food  should  be  taken  away 
and  not  offered  again  until  the  next  feeding  time 
comes. 

9.  In  any  acute  illness  the  amount  of  food  should 
be  much  reduced  and  the  food  made  more  dilute  than 
usual.  If  there  is  fever,  no  solid  food  should  bo 
given.  If  the  child  is  already  upon  a  milk  diet,  this 
should  be  diluted,  and  in  some  cases  partially  pep- 
tonized. 

10.  In  very  hot  weather  the  same  rules  hold,  to 
give  less  food,  particularly  less  solid  food,  and  more 
water. 

FOOD  FORMULAS 

Beef  Juice. — One  pound  of  rare  round  steak,  cut 
thick,  slightly  broiled,  and  the  juice  pressed  out  by 
a  lemon-squeezer,  or,  better,  a  meat-press.  From 
two  to  four  ounces  of  juice  can  generally  be  ob- 
tained. This,  seasoned  with  salt,  may  be  given  cold, 
or  warmed  by  placing  the  cup  which  holds  it  in 
warm  water.  It  should  not  be  heated  sufficiently  to 
coagulate  the  albumin  which  is  in  solution,  and 
which  then  appears  as  flakes  of  meat  floating  in  the 
fluid. 


FOOD   FORMULAS  147 


Beef  Juice  by  the  Cold  Process. — One  pound  of 
finely  chopped  round  steak,  six  ounces  of  cold  water, 
a  pinch  of  salt;  place  in  a  covered  jar  and  stand  on 
ice  or  in  a  cold  place,  five  or  six  hours  or  overnight. 
It  is  well  to  shake  occasionally.  This  is  now  strained 
and  all  the  juice  squeezed  out  by  placing  the  meat  in 
coarse  muslin  and  twisting  it  very  hard.  It  is  then 
seasoned  and  fed  like  the  above. 

Beef  juice  so  made  is  not  quite  as  palatable  as 
that  prepared  from  l)roilcd  steak,  but  it  is  even  more 
nutritious,  and  is  more  economical,  as  fully  twice  as 
much  juice  can  be  obtained  from  a  given  quantity  of 
meat.  Beef  juice  ])repared  in  either  of  these  ways 
is  greatly  to  be  ])referred  to  the  beef  extracts  sold. 

Mtdion  Jiroili. — One  pound  of  finely  chopped 
lean  mutton,  including  some  of  the  bone,  one  pint 
cold  water,  ])inch  of  salt.  Cook  for  three  hours  over 
a  slow  fire  down  to  half  a  pint,  adding  water  if  neces- 
sary ;  sti'ain  tlirougli  muslin,  and  when  cold  carefully 
reuiovf!  the  fat,  adding  more  salt  if  re(|uired.  It  may 
be  fed  warm,  (ir  cold   in  the  form  of  a  jelly. 

A  very  nutritious  and  delicious  ])rotli  is  made  by 
Thickening  this  with  cornstarch  or  ai'rowroot,  cook- 
ing fnr  ten  minntes  and  tlien  adding  thive  ounces  of 
III  ilk.  or  one  ounce  and  a  half  of  thin  cr(>am,  to  a  half 
jiiiiT   ('t"  broth. 


148       THE  CAKE   AND   FEEDING  OF  CHILDREN 

Chicken,  Veal,  and  Beef  Broths. — These  are 
niiule  and  used  in  i)recisely  the  same  manner  as  mut- 
ton hroth. 

Meat  Pulp. — A  rare  piece  of  round  or  sirloin 
steak,  the  outer  part  having  been  cut  away,  is 
scraped  or  shredded  with  a  knife ;  one  teaspoonful 
to  one  tablespoonful  may  be  given,  well  salted,  to  a 
child  of  eighteen  months.  Scraping  is  much  better 
than  cutting  the  meat  fine. 

For  this  on  a  large  scale,  as  in  institutions,  a 
Hamburg-steak  cutter  may  be  employed. 

Junket,  or  Curds  and  Whey. — One  pint  of  fresh 
cow's  milk,  warmed ;  pinch  of  salt ;  a  teaspoonful 
of  granulated  sugar ;  add  two  teaspoonfuls  of  Fair- 
child's  essence  of  pepsin,  or  liquid  rennet,  or  one 
junket  tablet  dissolved  in  water;  stir  for  a  moment, 
and  then  allow  it  to  stand  at  the  temperature  of 
the  room  for  twenty  minutes,  or  until  firmly  coagu- 
lated ;  place  in  the  ice  box  until  thoroughly  cold. 
For  older  children  this  may  be  seasoned  with  grated 
nutmeg. 

Whey. — The  coagulated  milk  prepared  as  above 
is  broken  up  with  a  fork  and  the  whey  strained  off 
through  muslin.  It  is  best  given  cold.  If  some 
stimulant  is  desired,  sherry  wine  in  the  proportion 
of  one  part  to  tw^elve,  or  brandy  one  part  to  twenty- 


FOOD   FORMULAS  149 


four,  may  be  added.     Whey  is  useful  in  many  cases 
of  acute  indigestion. 

Barley  Jelly  from  the  Grains. — Three  table- 
spoonfuls  of  jjearl  barley ;  soak  overnight,  then  place 
this  in  one  quart  of  fresh  water;  add  pinch  of  salt, 
and  cook  in  double  boiler  steadily  for  four  hours 
down  to  one  pint,  adding  water  from  time  to  time; 
strain  through  muslin.  When  cold  this  makes  a 
rather  thick  jelly.  If  a  thinner  gruel  (barley  water) 
is  desired,  one  half  the  quantity  of  barley  should  be 
used. 

Oaf,  WJieaf,  or  Tiice  Jelly. — These  are  prepared 
from  oatmeal,  wheaten  grits,  and  rice  grains  in  the 
same  manner  as  the  barley  jelly. 

linrley  Jelly  from  ilie  Flour. — Either  Robin- 
son's jiatcnt  ])ar]ey  or  pre])ared  barley  flour  of  the 
Heahli  Food  ('om])any  may  1)(^  used.  One  rounded 
tab]es])r)r»iifiil  of  the  tloiir.  thoroughly  blended  with 
a  little  cold  water,  is  added,  stirring,  to  one  ]unt  of 
boiling  water  containing  a  ])iiich  of  salt:  cook  for 
twenty  minutes  in  a  double  boiler,  and  strain.  'I'his 
make.-  a  jelly  of  about  the  consistency  of  that  ma<le 
from  the  grains  as  above.  Tt  is  essentially  the  same 
in  c.iiii  j)osit  ioTi.  and  nmcli  less  ti'oulde  to  ])re])are.  A 
thinner  irrne]  (barley  water)  is  made  l)y  using  lialf 
the  (plant ily  of  Hour. 


150       THE  CARE  AND   FEEDING   OF  CHILDREN 

When  this  is  to  be  mixed  with  milk,  it  is  well  to 
add  the  milk  to  the  barley  gruel  before  removing 
from  the  fire,  and  stir  two  or  three  minutes,  or  until 
the  milk  has  nearly  reaehed  the  boiling  point,  when 
it  should  be  removed  and  bottled. 

Oat  or  Wheat  Jelly  from  the  Flour. — These  are 
made  from  the  prepared  oat  flour  of  the  Health  Food 
Com]iany  or  Ilubbell's  prepared  wheat  flour.  They 
are  used  like  the  barley. 

Imperial  Granum. — This  is  prepared  and  used 
in  precisely  the  same  way  as  the  barley  flour  above 
mentioned,  the  gruel  being  mixed  with  milk  before 
it  is  removed  from  the  fire. 

Albumin  M\iler. — The  white  of  one  fresh  egg; 
half  a  pint  of  cold  water ;  pinch  of  salt ;  teaspoonful 
of  brandy.  This  should  be  shaken  thoroughly  and 
fed  cold  either  with  a  spoon  or  from  a  bottle.  It  is 
useful  in  cases  of  vomiting,  and  can  sometimes  be 
retained  by  a  very  irritable  stomach. 

Lime-water. — One  heaping  teaspoonful  of  slaked 
lime;  one  quart  boiled  or  distilled  water;  place  in  a 
corked  bottle  and  shake  thoroughly  two  or  three 
times  during  the  first  hour.  The  lime  should  then 
be  allowed  to  settle,  and  after  twenty-four  hours  the 
upper  clear  fluid  carefully  poured  or  siphoned  off 
for  use. 


FOOD   FORMULAS  151 

Dried  Bread. — Either  stale  or  fresh  bread  inav 
he  used;  it  is  cut  in  thin  slices  and  placed  in  the 
iiven,  with  the  door  0})en,  and  quickly  dried  until 
it  is  cris]),  hut  not  browned.  It  is  in  numy  res])ect3 
])referable  to  crackers  for  little  children. 

Coddled  E(j(j. — A  fresh  eati',  shell  on.  is  placed 
in  bdilint!,'  water  which  is  immediately  after  removed 
fi'oiu  the  tire.  'Idie  eaa'  then  cooks  slowly  in  the 
wafer,  which  ai'ailually  codls,  for  seven  or  eic'lit  min- 
utes, wlicn  the  white  should  be  about  the  consistency 
(if  j<'lly.  For  a  (hdicate  digestion  the  white  only 
sh(iuld  be  ij'iven.  with  salt;  it  can  be  easily  separated 
from  the  volk. 


PART   IV 
MISCELLANEOUS 


IV 
MISCELLANEOUS 

Tin-:   B(jwi-:ls 

How  many  morenienfs  dailij  sltould  an  infant 
Jincc  (luring  (he  first  feir  irecLs  of  life? 

I'siiallv  two  or  three  ii  day  for  the  first  week, 
and  then  one  or  tw(j  each  day. 

I  foil'  niainj  after  a  child  is  a  month  old? 

A  heahhy  t-liikl  should  have  at  least  one  move- 
nienr  each  (hiy  ;  iiiaiiv  have  two  and  some  more  than 
tw(»;  hut  it  is  the  chai'acter  of  the  stooLs  rather  than 
thcii-  nuinher  whicli  is  t(j  he  taken  as  tlie  evidence 
of  per  feet    diiicstion. 

II  hut  IS  the  (ippcaranrc  of  a  liPaltliy  tnorement 
of  (I  child  irho  is  tdl/nuj  notliin;/  hut   milk? 

It  is  soft,  _velh)W,  and  smooth,  contain iuii;  no 
hiiiips. 

\Vlir)i   lire   Ihr  stools  (hi rl'  hroirti   or  hhiclr.^ 
W'hih'  takini:"  hismulh,  iron,  and  sdttietinies  whtni 
takinir  iiiueh   meat   or   he(d'    iui<*e;   also   while   takinii 


156       THE   CARE   AND   FEEDING   OF   CHILDREN 


many  of  tlie  prepared  foods.  They  may  be  dark 
brown  or  black  from  blood.  This  last  is  a  condition 
\vhich  may  indicate  serious  illness. 

llow  may  a  child  he  trained  to  he  regular  in  the 
action  of  its  howels? 

By  endeavouring  to  have  them  move  at  exactly 
the  same  time  every  day. 

At  u-hat  age  may  an  infant  he  trained  in  this 
way  ? 

Usually  by  the  second  month  if  training  is  begun 
early. 

What  is  the  hest  method  of  training? 

A  small  chamber,  about  the  size  of  a  pint  bowl, 
is  placed  between  the  nurse's  knees^  and  upon  this 
the  infant  is  held,  its  back  being  against  the  nurse's 
chest  and  its  body  firmly  supported.  This  should  be 
done  twice  a  day,  after  the  morning  and  afternoon 
feedings,  and  always  at  the  same  hour.  At  first  there 
may  be  necessary  some  local  irritation,  like  that  pro- 
duced by  tickling  the  anus  or  introducing  just  inside 
the  rectum  a  small  cone  of  oiled  paper  or  a  piece  of 
soap,  as  a  suggestion  of  the  purpose  for  which  the 
baby  is  placed  upon  the  chamber ;  but  in  a  surpris- 
ingly short  time  the  position  is  all  that  is  required. 
With  most  infants,  after  a  few  weeks  the  bowels  will 
move  as  soon  as  the  infant  is  placed  on  the  chamber. 


SLEEP  157 

What  advantage  has  sucJi  training? 

It  forms  the  habit  of  having  the  bowels  move 
regularly  at  the  same  hour,  which  is  a  matter  of 
great  importance  in  infancy  and  makes  regularity 
in  childhood  much  easier.  It  also  saves  the  nurse 
much  trouble  and  labour. 

SLEEP 

Should  a  child  sleep  in  the  same  hed  icith  its 
mother  or  nurse? 

Under  no  circumstances,  if  this  can  possibly  be 
a\'oided.  Very  young  infants  have  often  been  smoth- 
ered by  their  mothers,  by  overlying  during  sleep.  If 
tli('  infant  slee{)S  with  the  mother,  there  is  always  the 
t»'m{)tation  to  frecjuent  nursing  at  night,  which  is  in- 
jiiri(jus  to  l)oth  mother  and  child.  Older  children 
also  should,  if  possible,  have  se])arate  beds;  many 
contagious  diseases  and  bad  habits  are  contracted  by 
children  sleeping  together. 

IIou'  should  (in   iiifuuf's  hed  he  prepared? 

d'lif  mattress  should  be  firm  ])ut  soft,  the  ])illo\v 
very  thin,  ;ind  the  C(iv('i'ing  not  excessive.  A  baby 
should  not  be  allowed  to  slcf])  always  in  the  same 
])osition,  but  should  be  changed  from  side  to  si(lc. 
Hair  piljriw?  are  useful  in  summer  and  for  children 
who  p('rspire  very  mu<di. 


158        THE   CARE   AND    FEEDING   OF   CHILDREN 

Hoxu  much  sleep  is  natural  for  a  newly  horn 
hahy'i 

A  babv  with  a  good  digestion  and  proper  food 
will  iisnally  sleep  at  this  period  about  nine  tenths 
of  the  time. 

IIow  much  should  a  hahy  sleep  at  six  months? 
About  two  thirds  of  the  time. 

Up  to  what  age  should  an  older  child  take  a  nap 
during  the  day  9 

Always  until  four  vears  old,  and  if  possible 
longer. 

At  ivhat  age  may  an  infant  go  all  night  without 
feeding  f 

At  five  months  a  child  should  not  be  fed  or 
nursed  between  10  p.  m.  and  6  a.  m.  At  two  years 
a  child  can  easily  go  from  6  p.  m.  to  6  a.  m.  without 
feeding. 

Row  should  a  hahy  he  put  to  sleep? 

The  room  should  be  darkened  and  quiet,  the 
child's  hunger  satisfied,  and  the  child  made  gen- 
erally comfortable  and  laid  in  its  crib  while 
awake. 

7s  roching  necessary? 

By  no  means.  It  is  a  habit  easily  acquired,  but 
hard  to  break,  and  a  very  useless  and  sometimes  in- 


SLEEP  159 

jurious  one.  The  same  may  be  said  of -sucking  a 
rubber  nip])le,  or  "  pacifier,"  and  all  other  devices 
for  })utting-  children  to  sleep. 

What  are  the  principal  causes  of  disturbed 
sleep  / 

As  (juier  peaceful  sleep  is  a  sign  of  perfect 
health,  disorders  of  sleep  may  be  produced  by  al- 
most anything  wliich  is  wrong  with  the  child. 

1.  Habitual  disturbance  of  sleep  in  infants  is 
UK'jst  frequently  associated  with  the  food  or  feeding. 
It  nuiy  be  from  the  discomfort  of  chronic  indigestion 
due  to  imi)roper  food.  In  bottle-fed  infants  it  is 
often  the  result  of  overfeeding;  in  those  who  are 
nursed  it  is  often  due  to  hunger.  A  common  cause 
is  frequent  night  feeding;  an  infant  who  is  fed  three 
or  four  times  fluring  the  night  is  almost  invariably 
a  Itad  sleepf'r. 

'2.  iJisturbf'd  slee])  or  slecplc.-siiess  may  1)0  due 
to  causes  pui'ely  nervr)us.  Such  are  bad  habits  ac- 
quircil  liy  faulty  ti-aiuiug;  as  when  the  nursery  is 
li;^ht«Ml  atid  the  child  taken  fi'diu  its  ci'ib  whenevei' 
it  wake-  <ir  cries;  oi-  when  some  (if  the  (Mjutrivances 
fi>v  iu'hicing  slcrq)  liavc  been  u-ed.  Any  excitement 
oi-  roiiipiiiu-  play  just  bcd'oi'c  j)('dtiiiic,  and  fears 
ai'iiu~<'<l  by  [licturcs  oi'  storie-,  are  t"i'e(|uent  causes, 
(liildrcn   wlio   inherit   fi'(;m   theii'   pai'ents   a   nerv(')us 


IGO       THE   CAKE   AND   FEEDING   OP   CHILDREN 

constitution    are    ospeciallv    likely    to    suffer    thus. 

3.  There  may  he  })hysi('al  discomfort  from  cold 
feet,  insufficient  or  too  much  clothing,  or  want  of 
fresli  air  in  the  sleeping  room. 

4.  Interference  with  breathing  due  to  obstruc- 
tion from  large  tonsils  or  adenoids.  These  cause 
great  restlessness  and  lead  a  child  to  assume  many 
different  postures  during  sleep,  often  lying  upon  the 
face  or  upon  the  hands  and  knees. 

5.  Chronic  pains  or  frequently  recurring  night 
pains  may  be  causes  of  disordered  sleep,  when  a  child 
wakes  with  a  sudden  sharp  cry.  In  infants  this  is 
most  often  due  to  scurvy,  sometimes  to  syphilis.  In 
older  children  it  may  be  the  earliest  symptom  of  dis- 
ease of  the  hip  or  spine. 

G.  Sleeplessness  and  disturbed  sleep  are  frequent 
whenever  the  general  condition  falls  much  below  a 
healthy  standard ;  e.  g.,  in  infants  who  arc  not  thriv- 
ing and  in  children  suffering  from  marked  anaemia. 

How  are  children  wlio  sleep  too  liUle,  or  whose 
sleep  is  constanily  disturbed,  io  he  Ireaied? 

Xever  by  the  use  of  soothing  sirups  or  other 
medicines.  Successful  treatment  consists  in  the  dis- 
covery and  removal  of  the  cause. 

Do  children  ever  sleep  too  much? 

It  is  doubtful  if  healthv  children  ever  do.     Ex- 


EXERCISE  161 


cessive  sleep  is  an  important  symptom  of  some  dis- 
eases of  the  brain.  Otherwise  it  seldom  if  ever  oc- 
curs unless  soothing  sirups  or  other  drugs  have  been 
given. 

EXERCISE 

Is  exercise  important  for  infants? 

It  is  as  necessary  for  them  as  for  older  children. 

llow  is  it  obtained? 

A  young  baby  gets  its  exercise  by  screaming, 
waving  its  arms,  kicking,  etc.  The  clothing  should 
not  be  so  tight  as  to  make  these  movements  impos- 
sible. At  least  twice  a  day  the  infant  should  bo 
allowed  for  fifteen  or  twenty  minutes  the  free  use  of 
its  limbs  by  permitting  it  to  lie  upon  a  bed  in  a 
wai'iii  room,  with  all  clothing  excejit  the  shirt,  stock- 
ings, and  naj)kin  removed.  Later,  when  in  short 
clothes,  the  baby  may  be  ])ut  upon  a  thick  blanket 
or  ([uilr  laid  upon  the  iloor,  and  bo  allowed  to  tundde 
about  at  will.  A  nursery  fence  two  feet  high,  made 
to  surrouinl  a  mattress,  is  an  excellent  device  and 
]iiak»'s  a  convenient  box  stall  for  the  young  animal, 
where  it  can  learn  to  use  both  its  arms  and  legs  with- 
out the  danger  of  injury.  Only  by  exercise  such  as 
this  (\()  the  muscles  have  an  op])ortunity  to  develop 
])roj)erly. 

11 


1()2        Till']   TARE   AXI)    FKKDING    OF   CHILDUKX 


THE    CRY 

Mlieii  is  crying  useful? 

In  the  newly  born  infant  the  cry  expands  the 
lungs,  and  it  is  necessary  that  it  should  be  repeated 
for  a  few  minutes  every  day  in  order  to  keej)  them 
well  expanded. 

IIow  much  crying  is  normal  for  a  very  young 
bahy? 

From  fifteen  to  thirty  minutes  a  day  is  not  too 
much. 

What  is  the  nature  of  this  cry? 

It  is  loud  and  strong.  Infants  get  red  in  the 
face  with  it;  in  fact,  it  is  a  scream.  This  is  neces- 
sary for  health.     It  is  the  baby's  exercise. 

When  is  a  cry  abnormal? 

When  it  is  too  long  or  too  frequent.  The  ab- 
normal cry  is  rarely  strong,  often  it  is  a  moan- 
ing or  a  worrying  cry,  sometimes  only  a  feeble 
whine. 

Wliat  are  the  causes  of  such  crying? 
Pain,  temper,  hunger,  illness,  and  habit. 

What  is  the  cry  of  pain? 

It  is  usually  strong  and  sharp,  but  not  generally 
continuous.     It  is  accompanied  by  contraction  of  the 


THE   CRY  163 

features,  drawing  up  of  the  legs,  and  other  symptoms 
of  distress. 

WJiat  is  lite  cry  of  hunger? 

It  is  usually  a  continuous,  fretful  cry,  rarely 
strong  and  lusty. 

Mluit  is  the  cry  of  temper? 

It  is  loud  and  strong  and  accompanied  by  kick- 
ing or  stiffening  of  the  body,  and  is  usually  violent. 

WJi/it  is  Oie  cry  of  illness? 

TluM'e  is  usually  more  of  fretfulness  and  moaning 
than  real  crying,  although  crying  is  excited  by  vei-y 
slight  causes. 

WJial  is  fhe  cry  of  in/l uh/oire  or  from  liahif^ 
Thi<  i-  often  heard  cvei'  in  very  youiig  infants, 
whct  cry  to  be  i-ocked,  to  be  caiM'ied  about,  sometimes 
for  a  light  in  the  room,  for  ii  b<^ittle  to  suck,  ny  for 
the  continuance  of  any  other  bad  liabit  which  has 
bef'M  acipiii-ed. 

I  foil-  rnn  irr  he  stire  flinf  n  rliihl  is  rri/inq  lo  he 
infliihird  ? 

It  it  <tops  immediatclv  w1icn  it  gets  wliat  it 
wants,  and  cries  when   it   i<  withdrawn   oi-  withheld. 

M  Ji'il  sliouJtJ  he  (To)ic  if  II  hnhif  crirs  af  niqlil^ 
r)rie  -honld  get  up  and  s.-e  that  the  cdiild  is  com- 


16-4   THE  CARE  AND  FEEDING  OF  CHILDREN 

fortablc — the  clothing  smooth  under  the  body,  the 
hands  and  feet  warm,  and  the  napkin  not  wet  or 
soiled.  If  all  these  matters  are  properly  adjusted 
and  the  child  simply  crying  to  be  taken  up,  it  should 
not  be  further  interfered  with.  If  the  night  cry  is 
habitual  some  other  cause  should  be  sought  (see 
page  121). 

How  is  an  infant  to  he  managed  that  cries  from 
temper,  habit,  or  to  be  indulged? 

It  should  simply  be  allowed  to  "  cry  it  out." 
This  often  requires  an  hour,  and  in  extreme  cases, 
two  or  three  hours.  A  second  struggle  will  seldom 
last  more  than  ten  or  fifteen  minutes,  and  a  third 
will  rarely  be  necessary.  Such  discipline  is  not  to 
be  carried  out  unless  one  is  sure  as  to  the  cause  of 
the  habitual  crying. 

Is  it  lihely  that  rupture  unll  he  caused  from  cry- 
ing 9 

Xot  in  young  infants  if  the  abdominal  band  is 
properly  applied,  and  not  after  a  year  under  any 
circumstances. 

LIFTING    CHII.BRElSr 

TIow!  shordd  a  young  bahy  he  lifted  from  its  bed? 

The  right  hand  should  grasp  the  clothing  below 

the  feet,  and  the  left  hand  should  be  slipped  beneath 


THE   TEMPERATURE  165 


the  infant's  body  to  its  head.     It  is  then  raised  upon 
the  left  arm. 

What  is  the  advantage  of  this? 

The  entire  spine  is  supported,  and  no  undue  pres- 
sure is  made  upon  the  chest  or  abdomen,  as  often 
happens  if  the  baby  is  grasped  around  the  body  or 
under  the  arms. 

IIow  should  a  child  old  enough  to  run  about  he 
lifted? 

Always  by  placing  the  hands  under  the  child's 
arms,  and  never  by  the  wrists. 

^yJlat  injury  may  he  inflicted  hy  lifting  the  child 
hy  the  irrists  or  hands? 

Often  serious  injurv  is  done  to  the  elbow  or 
shoulder  joints. 

TIFF.    TK^rPKKATURE 

^y]l^f  is  the  normal  temperature  of  an  infant? 

Tlic  normal  temperature  varies  more  than  in 
adult-;.  Tn  tlio  rectum  it  usually  fluctuates  between 
0^^'^  and  r»0.r>^  F.  ;  a  rectal  temperature  of  07.5°  F. 
or  fif  100.5"  F.  is  of  no  ini])ortancc  whatever  un- 
less   it   con  tin  UPS. 

^yhr^rr•  should  the  temperature  of  infants  and 
yovug  children  he  f alien? 


166        THE   CARE   AND    FEEDING    OF   CHILDREN 


The  rectum  is  altogether  the  best  place,  and  next 
to  this  the  groin.  The  rectal  temperature  is  from 
half  a  degree  to  a  degree  higher  than  that  in  the 
groin. 

IIow  long  should  the  thermometer  he  left  in 
ylace  to  take  the  temperature? 

Two  minutes  in  the  rectum,  and  five  minutes  in 
the  groin. 

7s  the  temperature  of  a  young  child  a  good  guide 
as  to  the  severity  of  its  symptoms  in  illness? 

As  a  rule  it  is.  A  temperature  of  100°  to  102^ 
F,  commonly  means  a  mild  illness,  and  one  of  104*^ 
F.  or  over  a  serious  one.  The  duration  of  the  fever 
is,  however,  even  more  important  than  the  height  of 
the  temperature.  It  should  be  remembered  that  in 
all  young  children  slight  causes  often  produce  a  high 
temperature  which  lasts  for  a  few  hours ;  one  should 
not  therefore  be  unduly  alarmed  unless  the  tempera- 
ture continues  high,  or  is  accompanied  by  other  im- 
portant signs  of  illness. 

7s  7iot  a  high  temperature  a  more  serious  symp- 
tom in  a  young  child  than  in  an  adult? 

The  opposite  is  rather  the  case.  Young  children 
are  extremely  sensitive  to  conditions  which  produce 
fever,  and  the  thermometer  often  gives  an  exagger- 
ated idea  of  the  severity  of  the  symptoms.     A  cause 


NERVOUSNESS  161 


which  in  an  adult  might  ]»rochK-e  a  temperature  of 
K'i^  Y.  or  103^  F.,  in  a  vouiig'  child  would  very 
likely  be  accom])anied  by  a  tem})erature  of  104^  or 
105'  F. 

^■ekvous>;ess 

Wliat  are  tlie  principal  causes  of  excessive  nerv- 
(uisic'ss  in  infants  and  young  cltildren,  and  ivliat  can 
he  done  to  prevent  this? 

'J"h(,'  most  im{)ortant  cause  is  the  delicate  striic- 
tiire  of  the  bi-ain  at  this  tiiue.  and  its  rapid  growth. 
Ii  grows  as  much  during  the  tirst  year  as  during  all 
the  rest  of  life.  'J  his  requires  (piiet  and  peaceful 
surrduudings.  Infants  who  are  naturally  nervous 
should  be  left  much  aloue.  should  see  but  few  people, 
should  1)0  jdayed  with  very  little,  and  should  never 
be  (piiete(l  with  soothing  sirup?  or  the  ^^  pacifier." 

.1/  irhat  age  niai/  plai/ing  iritJi  Ijahies  ])e  hrgun? 

Ijabies  under  six  months  old  should  never  be 
phiye<l  with  ;  and  the  less  of  it  at  any  time  the  bet- 
ter for  the  infant. 

W'l/nl  hfirni  is  done  hg  playing  irilJi  very  young 
hahics' 

Tlifv  are  made  nervous  and  irritable,  slee]i  bad- 
Iv,  and  suffer  from  indigestion  and  in  many  other 
re.~j)ects. 


168       THE  CARE   AND   FEEDING   OF  CHILDREN 

When  may  young  children  he  played  with? 
If  at  all,   in  the  inorniiig,  or  after  the  iniddaj 
nap;  but  never  just  before  bedtime. 

TOYS 

What  points  should  guide  one  in  selecting  toys 
and  playthings  for  an  infant? 

The  instinct  in  a  baby  to  put  everything  into  the 
mouth  is  so  strong  that  nothing  should  be  given  that 
cannot  be  safely  treated  in  this  way.  Hence  one 
should  choose  things  which  are  smooth,  those  which 
can  be  easily  washed,  and  those  which  cannot  be 
swallowed. 

One  should  avoid  (1)  toys  with  sharp  points  or 
coimers;  (2)  those  with  loose  parts  that  might  be  de- 
tached or  broken  off  and  swallowed;  (3)  small  ob- 
jects which  might  be  swallowed  or  pushed  into  the 
nose  or  car,  such  as  coins,  marbles,  and  safety-pins, 
also  beads  and  buttons  unless  strung  upon  a  stout 
cord;  (4)  painted  toys;  (5)  those  covered  with  hair 
or  wool.  Infants  have  often  been  severely  injured 
by  swallowing  what  they  have  pulled  off  from  their 
small  toy  animals. 

What  points  are  to  he  considered  in  selecting  the 

toys  and  playthings  of  a  child  over  two  years  old? 

It  should  be  remembered  that  toys  are  not  mere- 


TOYS  1G9 

ly  a  source  of  amusement,  but  that  they  have  an. 
educational  value  as  well.  Those  are  therefore  to 
be  preferred  the  use  of  which  develops  the  child's 
imagination,  and  with  which  he  can  be  taught  to 
amuse  himself.  For  boys  nothing  can  surpass  blocks, 
toy  soldiers,  balls,  engines,  and  cars ;  and  for  girls, 
dolls  and  housekeeping  sets.  The  complicated  me- 
chanical toys  now  so  much  in  vogue  give  only  a 
momentary  pleasure,  and  as  soon  as  the  wonder  at 
their  operation  has  worn  off,  they  liave  lost  interest 
for  the  child  except  that  which  he  gets  in  breaking 
them  to  see  how  the  thing  worked. 

What  important  tilings  can  he  taught  children 
U'lth  their  toys  and  how  may  this  he  done? 

Tlie  inuigination  may  be  developed,  and  children 
may  be  trained  to  habits  of  neatness,  order  and  regu- 
larity, and  to  concentration  of  mind. 

To  this  end  toys  should  ])e  kept  in  an  orderly 
way  upon  a  slielf  in  the  nursery  or  in  a  closet,  never 
]iiled  in  ii  miscellaneous  heaj)  in  the  corner  of  tlu? 
room,  ('hildren  should  select  their  toys  and  play 
with  one  thing  at  a  time,  which  they  should  Ix;  taught 
to  put  away  in  its  place  before  another  is  given. 
They  should  never  be  allowed  to  have  a  dozen  tilings 
strewn  about  the  room  at  one  time,  with  none  of 
which  they  are  occupied. 


170        THE   CAKE   AND    FEEDING    OP   CHILDREN 


KISSING 

Air  there  any  valid  ohjeeiions  to  kissing  in- 
fants? 

Tlicro  are  many  serious  objections.  Tuberculo- 
sis, (.li])htlieria,  and  many  otlier  grave  diseases  may 
be  communicated  in  tliis  way.  The  kissing  of  in- 
fants upon  the  mouth  by  other  children,  by  nurses,  or 
by  ])eople  generally,  should  under  no  circumstances 
be  ])ermitted.  Infants  should  be  kissed,  if  at  all, 
upon  the  cheek  or  forehead,  but  the  less  even  of  this 
the  better. 

CONVULSIONS 

What  sltould  he  done  for  a  child  in  convulsions 
before  a  doctor  arrives? 

Keep  the  child  perfectly  quiet  "with  ice  at  the 
head,  put  tlie  feet  in  a  mustard  bath,  and  roll  the 
entire  body  in  large  towels  which  have  been  dipped 
in  mustard  water  (two  heaping  tablespoonfuls  of 
mustard  to  one  quart  of  tepid  water),  and  have 
plenty  of  hot  water  and  a  bath  tub  at  hand,  so  that 
the  doctor  can  give  a  hot  bath  if  he  thinks  it  advis- 
able. 

^yhen  is  a  hot  hath  useful? 

If  the  convulsions  have  continued  until  the  pulse 
is  weak,  the  face  very  pale,  the  nails  and  lips  blue, 


FOREIGN    BODIES  171 

and  the  feet  and  hands  cold,  the  hot  bath  will  be 
useful  by  bringing  blood  to  the  surface  and  relieving 
the  heart,  lungs,  and  brain. 

How  should  the  hath  he  given? 

The  temperature  should  not  be  over  lOG^  F. ; 
this  should  always  be  tested  by  a  thermometer  if  one 
can  be  obtained.  Without  this  precaution,  in  the  ex- 
citement of  the  moment,  infants  have  frequently 
been  put  into  baths  so  hot  that  serious  and  even  fatal 
burns  have  been  produced.  If  no  thermometer  is 
available  the  nurse  may  plunge  her  arm  to  the  elbow 
int(_)  the  water.  It  should  feel  warm,  but  not  so  hot 
a<  to  be  at  all  uncomfortable.  One  half  a  teacupful 
of  powdered  mustard  added  to  the  bath  often  adds 
to  its  efficacy. 

FOREIGN    BODIES 

What  should  ho  done  if  a  foreign  hody  has  heen 
siraHoired? 

First,  examine  the  throat  with  the  finger  to  see  if 
it  has  lodged  there,  and  if  so  remove  it.  If  it  has 
j)assed  fi'om  the  throat  it  has  usually  gone  into  the 
.-tomach. 

W'Jtal  should  he  done   in   fJiis  rase? 
Ci'wc   the   child    ])lcnty   of  dry   food,   like   bread. 
j)OTato,   ete.,   but   under   no   circumstances   eitlier   an 


172        THE   CARE   AND    FEEDING   OF   CHILDREN 

emetic  or  cathartic.     An  infant  may  have  its  usual 
food. 

W]tat  harm  would  a  cathartic  do? 

It  is  likely  to  hurry  the  foreign  body  too  rap- 
idly through  the  intestine  and  in  this  way  do  harm ; 
otherwise  it  becomes  coated  with  faical  matter 
and  passes  the  intestine  usually  without  doing 
injury. 

What  should  he  done  if  a  child  gets  a  foreign 
body  into  the  ear? 

Unless  this  can  easily  be  removed  with  the  fin- 
gers it  should  not  be  meddled  with,  for  it  is  likely 
to  be  pushed  farther  into  the  ear.  The  child  should 
be  taken  to  a  physician. 

What  should  he  done  if  there  is  a  foreign  hody 
in  the  nose? 

The  child  should  blow  his  nose  strongly  while 
the  empty  nostril  is  compressed.  Unless  this  removes 
it  a  physician  should  be  called.  Meddlesome  inter- 
ference is  always  harmful. 

COLIC 

What  are  the  symptoms  of  colic? 
There   is  a  strong,   hard  cry,  which  comes  sud- 
denly and  returns  every  few  minutes.     With  this 


EARACHE  173 


there  is  drawing  up  of  the  feet,  contraction  of  the 
muscles  of  the  face,  and  other  signs  of  pain.  The 
abdomen  is  usually  tense  and  hard. 

What  should  he  done  for  a  baby  with  colic? 

First,  see  that  the  feet  are  warm.  Place  them 
against  a  hot-water  bag,  or  hold  them  before  an  open 
fire ;  apply  a  hot  flannel  to  the  abdomen,  or  let  the 
child  lie  upon  its  stomach  across  a  hot-water  bag. 
If  the  colic  continues,  a  half  teacupful  of  warm 
water  containing  ten  drops  of  turpentine  may  be  in- 
jected into  the  bowels  with  a  syringe;  at  the  same 
time  the  abdomen  should  be  gently  rubbed  so  as  to 
start  the  wind.  If  the  gas  is  in  the  stomach,  half  of 
a  soda  mint  tablet  nuiy  be  given  in  a  tablespoonful 
of  very  warm  water. 

EARACHE 

^yJ^at  are  the  sijmptouis  of  earache? 

The  pain  is  generally  severe  and  accompanied  by 
a  -harp  scream  ;  the  child  often  puts  the  hand  to  the 
atfccted  ear,  or  cries  whenever  it  is  toucluMl.  The 
pain   is  likely  to  l»e  ])rolonged   and  continuous. 

Uoir  slioutd  a   diitd  viih   rararJie   he   treated^ 
I'he  ear   should   be    irrigated    with    a   solution    of 
])oric  ■,{(•](]   ftwenty  grains  to  the  ounce)   as  warm  as 
can  be  borne.     Dry  heat  may  then  b(_^  aj)y)lied  in  sev- 


174        THE   CARE   AND   FEEDING    OF   CHILDREN 

eral  ^vavs.  The  ear  having  been  first  covered  with 
cottt>n,  a  small  hot-water  bag  or  one  filled  with  hot 
salt  or  bran,  may  be  bound  over  it  with  a  bandage ;  or 
a  small  butter  plate  heated  in  hot  water  may  be  used 
in  the  same  way.  The  hot-water  bag  may  be  held 
against  the  ear  or  the  child  may  lie  with  his  head 
upon  it.  The  use  of  such  substances  as  oil  and  lau- 
danum in  the  ear  is  not  to  be  recommended. 

CROUP 

What  are  the  symptoms  of  croup? 
There  is  a  hollow,  dry,  barking  cough,  with  some 
difficulty  in  breathing. 

^Vhen  is  this  likely  to  come  on? 
Usually  at  night. 

7s  simple  croup  dangerous? 

The  ordinary  croup  of  infants  is  spasmodic 
croup,  and  is  very  rarely  dangerous,  although  the 
symptoms  seem  ver}'  alarming. 

What  are  the  symptoms? 

In  a  mild  attack  there  is  simply  noisy  breathing, 
especially  on  drawing  in  the  breath,  wath  a  tight, 
barking,  or  croupy  cough.  In  a  severe  attack  the 
cliikrs  breathing  is  more  noisy  and  becomes  difii- 
cult. 


COXTAGIUU.S    DISEASES  175 


WJiat  is  the  dangerous  form  of  croup ^ 
Menibranoiis  croup,  which  is  tlic  same  thing  as 
diphtheria  of  the  hirynx. 

How  dues  (his  develop.'' 

(iradiuillv:  very  rarely  docs  it  come  on  sud- 
lieidy. 

117/^//  sJtuuId  he  done  for  a  hahy  who  has  spas- 
modic croup? 

ddie  room  should  be  very  warm,  hot  cloths  or  poul- 
tices shduld  he  apj)lied  over  the  throat,  and  either  a 
cruup  kettle  or  an  ordinary  tead<ettle  kept  boiling  in 
the  room.  This  is  more  efficacious  if  the  child  is 
placed  in  a  tent  made  by  a  raised  umbrella  with  a 
slieet  tlircnvn  o\-er  it,  and  the  steam  introduced  be- 
neath the  tent.  If  the  syni])toms  are  urgent,  ten 
drops  of  tIic  siruji  of  i])ecac  sliould  be  given  every 
iifrccn  minutes  until  free  voiniting  occurs.  When- 
ever rlie  syni[)toiii>  roach  a  ])oiiit  whei'c  bi'eathing  l)c- 
comes  (liflicult,  a  doctor  should  be  sunnnoned  witliout 
delay. 

coxTAorors   disk  asks 

]\  Jial  (ire  llir  fir>^l  sijtn jilouis  of  uirasjes^ 
Mca-lcs    coiiics   (i\\    i-atboi'   gi'adiially    witb    ci)Ugli, 
-iM-oziiin-,   watery  eyes   and    iio-e.   iniicli    like  an   ordi- 
nary rdld    in   tbe  bead.       Tbe  ei'uptioii   appears  after 


17G       THE   CARE   AND  FEEDING   OP  CHILDREN 

ihn'c  or  four  days,  iirst  upon  the  face  and  neck  as 
small  red  spots,  and  spreads  slowly  over  the  body. 

7s  measles  a  serious  disease? 

In  infants  and  during  the  winter  season  it  is 
likely  to  be  very  serious  on  account  of  the  danger 
of  bronchitis  and  pneumonia,  which  frequently  ac- 
company it.  In  children  over  four  years  old  it  is 
generally  not  severe.  Xo  child  should  be  voluntarily 
exposed  to  this  disease,  and  particularly  one  who  is 
delicate  or  prone  to  disease  of  the  lungs  should  be 
i:)rotected  against  it. 

When  and  Jiow  is  measles  contagious? 

Measles  may  readily  be  conveyed  from  the  very 
beginning  of  the  catarrh,  two  or  three  days  before 
any  eruption  is  present.  It  is  not  often  carried  by 
healthy  persons.  Its  poison  does  not  cling  long  to 
a  sick  room. 

\Miat  is  German  measles? 

German  measles,  or  rubella,  is  a  distinct  disease 
and  has  nothing  to  do  with  ordinary  measles.  It  is 
extremely  rare  for  a  child  to  be  much  sick  with  it. 
There  is  usually  a  very  extensive  eruption  which 
may  cover  the  body,  but  few  other  symptoms. 

What  are  the  jirst  symptoms  of  scarlet  fever? 
Generally  it  comes  suddenly,  with  vomiting,  high 


CONTAGIOUS   DISEASES  177 

fever,  and  sore  throat.  The  e]-ii])tinn  iisuallv  ap- 
jiear?  within  twenty-four  hours  as  a  red  ])lush,  tirst 
upon  the  neck  and  chest,  and  s])reads  rajiidly. 

^V]lCN  and  Ituir  is  scarlet  fever  contagious .'' 
Scarlet  fever  is  only  slightly  contagious  for  the 
first  one  or  two  days  of  the  attack.  It  is  most  con- 
tagious at  the  height  of  the  disease  and  during 
des(punnation.  It  may  he  carried  hy  healthy  ])ers(uis 
and   hy  the  clothing  or  hedding  from  the  sick  room. 

11  oil-  does  (i-Jtooping-cotifjlt  tx'cjin? 

For  a  week  or  ten  days  it  cannot  he  distinguished 
from  an  ordinary  cold  on  the  chest.  Then  the  attacks 
<){  cougliing  grafhuilly  hecouie  more  severe  and  \'om- 
itiug  may  follow.  After  a  severe  coughing  ht  the 
hi-eati)  is  caught  with  a  })eculiar  n(jise  known  as  the 
'■  wlioop." 

Jloir  does  rli  /cken-po.r  /je;/in.'' 

!t  usmdiy  comes  (»ut  gi'a(hially,  as  widely  scat- 
tered ])impl('<  over  tlie  scalp,  faee,  and  IxkIv.  tiiauy 
of  which  soon  hecouie  small  \'esicles,  n.'seudtliug  tiny 
hii-tcr-.  'I'hcre  is  itching  and  locnl  discomfort  Imt 
little  fever,  and  the  child  rarely  seems  to  he  \"erv  ill. 

Ho/r  does  d iplttJieria   begin? 

Sometimes  suddeidy,  hut  usually  gradiudly.  with 

>orc   throat    am!    swcdling  of  the  glands   of   the   neck, 
1-2 


178   THE  CARE  AND  FEEDING  OF  CHILDREN 

with  white  patehos  upon  the  tonsils,  or  a  free  dis- 
charge, whieli  niaj  be  Woody,  from  the  nostrils. 

How  does  mumps  he  gin  f 

As  a  swellinii;  T;iion  the  jaw,  beneath  the  ear.  As 
it  increases  it  extends  forward  upon  the  cheek  and 
backward  behind  the  ear.     It  affects  one  or  both  sides. 

]\[nnips  is  not  very  common  in  yonng  children, 
and  in  them  it  is  nsnally  mild.  After  twelve  or 
thirteen  years  it  is  likely  to  be  more  severe. 

II ow  long  after  exposure  do  the  first  symptoms 
appear  in  the  different  diseases? 

In  scarlet  fever  in  from  three  to  five  days,  rarely 
later  than  a  week ;  in  measles  in  from  nine  to  fonrteen 
days,  occasionally  as  late  as  twenty  days;  in  wlioop- 
ing-congh  in  from  one  to  two  weeks ;  in  chicken-pox 
in  from  fonrteen  to  sixteen  days;  in  German  measles 
in  from  ten  to  sixteen  days.  In  diphtheria  the  time 
varies  mnch ;  it  may  be  only  one  day,  and  it  may  be 
one  or  two  weeks.  In  mumps  it  is  nsnally  a  little 
less  than  three  weeks,  the  average  being  twenty  days. 

WJiiclb  of  tliese  diseases  are  most  contagious? 

]\Ieasles  and  chicken-pox  are  very  contagious,  and 
very  few  children  who  have  not  had  them  can  come 
near  a  |x^rson  suffering  from  either  disease  without 
taking  it.  Whooping-cougli  is  almost  as  contagions 
as  measles,  and  for  young  babies  even  more  so.     A 


CONTAGIOUS   DISEASES  179 

very  close  exposure  is  not  necessarv  in  the  ease  of 
<-itljer  of  these  diseases,  and  whooping-cong-h  ean 
undoubtedly  be  contracted  in  the  open  air.  Scarlet 
fever  and  diphtheria  are  nnich  less  contagions ;  for 
lioth  of  these  a  pretty  close  exposnre  is  necessarv. 

Iloir  lung  should  a  child  with  any  of  these  dis- 
/ (is/'s  he  Irept  nivaij  from  otlwr  children- 

\\"\\\\  measles,  for  two  Aveeks  after  the  rash  has 
gone;  with  scarlet  fever,  for  at  least  fonr  weeks  after 
tlie  rasli  has  gone,  and  longer  if  the  peeling  is  not 
ovei'  or  if  the  ears  are  running;  with  whooping- 
cough,  foi-  two  months,  or  so  long  as  the  paroxysmal 
cough  continnes;  with  chicken-})ox,  until  all  crusts 
ha\e  fallen  off,  or  for  about  tlire(^  weeks  after  the 
eruption  a])])ears;  with  (Jerman  measles  for  one  week 
after  the  eruption  has  faded;  with  di])htheria,  at 
lea>t  leu  days  after  the  tbi'oat  is  well  in  a  vei'v  mild 
ca>e,  aiul  foui'  weeks  if  the  case  has  been  se\-ei'e ; 
with  luumps  for  one  we(^k  after  tlie  swelling  has  gone. 

11  IkiI  should  he  done  when  a  cliild  shows  tlie  jirxl 
.'<;/ni /i/oius  of  serious  dlness'/ 

ilic  cliild  should  be  put  1o  bed.  If  it  is  an  iii- 
•jiiit.  llie  food  sliould  be  diluted  to  one  half  the  usual 
-ii'(  !ii:i  li  ;  if  ail  oblei'  cbild,  oidy  lluid  food  should 
be  given.  If  llie  child  seems  feverish,  takf>  the  teiu- 
[(  rature.      If  the  bowel-;  ai'c  const  i])ate(l,  give  a  tea- 


180        TlIK   CARE   AND   FEEDING   OP   ClIILDKEX 

spoonful  of  castor  oil,  but  no  other  medicine  without 
the  doctor's  orders.  Send  for  the  doctor  at  once,  and 
until  he  conies  carefully  exclude  all  other  children 
from  the  room. 

By  what  nursery  training  may  the  examination 
and  treatment  of  sick  children  he  made  much  easier'? 

By  teaching  all  children  to  gargle,  to  show  the 
throat,  to  take  pills,  and  by  constantly  teaching  them 
to  regard  the  doctor  as  the  child's  best  friend,  and 
his  visits  as  a  great  treat.  On  no  account  should  a 
child  be  frightened  into  obedience  by  threats  of  what 
the  doctor  will  do. 

With  care  and  patience  most  children  may  be 
taught  to  gargle  and  take  pills  at  four  or  five  years, 
and  to  show  the  throat  willingly  at  two  or  three.  All 
these  m.atters  should  be  made  a  part  of  the  child's 
education. 

SCURVY 

^Yhat  is  scurvy  and  how  is  it  produced? 

Scurvy  is  a  disease  of  general  nutrition,  usually 
caused  by  the  long-continued  use  of  improper  food. 
Most  of  the  cases  come  from  the  use  of  the  prepared 
infant's  foods  sold  in  the  stores,  especially  when  they 
are  given  without  fresh  milk ;  occasionally  the  use 
of  condensed  milk  and  of  sterilized  milk  is  follow^ed 
by  scurvy ;  sometimes  it  is  seen  when,  owing  to  feeble 


SCUKVY     .  181 

digestion,  it  has  been  necessary  to  make  cow's  milk 
very  weak  for  a  long  time. 

n7/«/  symptoms  are  seen  in  an  infant  with 
scurry  / 

At  first  there  is  only  indefinite  and  occasional 
soreness  in  the  legs  so  that  the  child  cries  out  when 
handled.  As  this  soreness  becomes  more  severe  the 
child  is  often  thought  to  have  rheumatism.  'J'he 
gums  swell  and  are  of  a  deep  purple  colour.  There 
may  be  bleeding  from  the  gums,  nose,  bowels,  or 
black-and-blue  spots  may  be  seen  upon  the  legs.  The 
ankles  and  knees  may  swell.  The  child  grows  very 
jiale,  loses  appetite  and  weight,  and  sleeps  badly. 

^VJlat  sliouJd  he  done  when  an  infant  shows  signs 
of  scurvy'/ 

d'he  diet  should  at  once  be  changed  to  fresh  milk, 
jir(i|)cr]y  modified  according  to  the  child's  digestion, 
but  not  sterilized  or  ])asteurized.  The  juice  of  a 
sweet  orange  should  be  given,  best  about  an  hour  be- 
forf-  the  f('e(liiig.  At  first  one  or  two  t(>aspoonfuls, 
four  or  five  times  a  day;  later,  more  may  be  given 
if  the  symptoms  are  not  imjtroved. 

I'ropcrly  treated  an  infant  with  scurvy  generally 
rf'covf'rs  y)rom])tly  and  (•om{)lctoly.  if  not  recog- 
ni-(-<].  or  untreated,  it  niav  cause  death. 


18.2        THE   CARE   AND    FEEDING   OF   CIIILDKEN 
CONSTIPATION 

When  it  is  necessary  to  move  the  hoivels  imme- 
diately, what  are  some  of  the  easiest  methods? 

An  injection  of  one  tablespoonful  of  sweet  oil 
may  be  given,  or  half  a  teaspoonful  of  glycerine  in 
one  tablespoonful  of  water,  or  a  teacupful  of  tepid 
soap  and  water,  or  a  glycerine  suppository.  None  of 
these  should  be  continued  excepting  under  the  physi- 
cian's directions. 

^^hat  sort  of  a  syringe  is  to  he  preferred  for  giv- 
ing an  injection  to  an  infant? 

The  bulb  syringe  is  the  simplest ;  this  consists  of 
an  oval  bulb  of  soft  rubber  and  a  soft  rubber  or  a 
hard  rubber  tip.     It  holds  one  or  two  oimces. 

AYhat  is  the  most  essential  thing  in  'preventing  or 
overcoming  constipation? 

The  formation  of  the  habit  of  having  the  bowels 
move  every  day  regularly  at  the  same  hour,  and 
proper  early  training  (see  page  15G). 

^Vhat  is  the  best  hour? 

In  most  cases  immediately  after  the  first  meal 
in  the  morning. 

What  are  some  simple  means  hy  wJiich  constipa- 
tion may  he  relieved? 

The  best  are  diet,  suppositories,  and  massage. 


COXSTIPATIOX  183 


The  changes  to  be  made  in  the  milk  of  consti- 
pated infants  have  been  mentioned  on  page  S2.  The 
addition  to  the  milk  of  some  of  the  malted  foods, 
snch  as  Mellin's  food  or  malted  milk,  is  sometimes 
useful.  For  little  children  the  fruit  juices  are  par- 
ticularly Ijeneticial  when  given  half  an  hour  or  more 
before  the  tirst  morning  feeding,  with  half  a  glass 
of  water. 

Tor  (dder  children  the  amount  of  white  bread, 
toa>t,  and  i)Otato,  should  be  reduced,  and  gr(^en  vege- 
tables, oatmeal,  and  Graham  bread  given,  ^vith 
plenty  cd"  fruit  twice,  a  day.  Kaw  scraped  apples  are 
>nnierimes  of  more  value  than  any  other  fruit. 

The  best  suppositories  for  continuous  use  are 
]irobably  the  gluten  suppositories  of  the  Health 
Tood  ( '(.iinpany.  One  shoidd  be  given  the  lirst 
thing  in  the  morning.  They  act  rather  slowly,  usu- 
ally in  al)Out  two  hours.  In  obstinate  cases  one  may 
also  be  used  at  l)edtinie.  Glycerine  sup]>ositories 
act  more  quickly,  but  are  too  ii-ritating  for  regu- 
lar use. 

.\ras-age  consists  in  rubbing  the  abdomen,  wliich 
mav  be  done  in  one  oi  two  ways:  T^>eginning  at  the 
right  grdin,  the  hand  is  carrie*!  up  to  the  rib-,  then 
acro-s  to  the  opposite  side,  then  around  to  tlie  left 
groin.  'l"he  ab(lr»men  is  stroked  gently  at  first,  and 
aftf'rward  dec{)er  pressure  u-ed  as  the  chihl  liecomes 


1S4        THE   CAKE   AND   FEEDING   OF   CIITLDREX 


accustomed  to  it.  The  second  method  is  by  rubbing 
the  (keeper  ])ai-ts  with  a  eircuhir  movement — tlie  fin- 
gers not  moving  upon  the  skin — making  a  series  of 
small  circles,  beginning  at  the  right  groin  and  fol- 
lowing the  same  course  as  described  above.  Either 
method  should  be  employed  for  six  or  eight  minutes 
twice  a  day,  at  almost  any  regular  time,  except  soon 
after  a  meal. 

DIAERIICEA 

In  case  a  child  is  taken  ivith  diarrhoea,  what 
should  he  done? 

With  a  moderate  looseness  of  the  bowels  in  an 
older  child,  solid  food  should  be  stopped,  and  boiled 
milk  given  diluted  with  gruel ;  the  child  should  be 
kept  perfectly  quiet,  as  walking  about  always  aggra- 
vates such  a  disturbance.  If  the  symptoms  are  more 
severe  and  attended  by  fever  and  vomiting,  all  milk 
should  be  stopped  at  once,  and  only  broth,  barley 
water,  or  some  thin  gruel  given.  Some  cathartic, 
usually  castor  oil,  is  required  with  a  severe  attack. 

If  the  patient  is  an  infant,  the  milk  should  be 
diluted  and  especially  should  the  fat  be  reduced 
(see  page  76).  In  severe  attacks  with  vomiting  or 
frequent  foul  stools,  all  food  should  be  stopped  for  at 
least  twelve  hours  and  all  milk  for  a  longer  time,  and 
the  bowels  freelv  moved  bv  a  cathartic. 


RAD    HABITS  185 


Why  is  a  catJiartic  necessary  if  tJie  movements 
are  already  frequent? 

Such  iiiovenients  are  nearly  always  due  to  an 
irritation  in  the  bowel,  set  up  by  the  fermenting 
food  which  has  not  been  digested.  The  diarrh<ea 
is  Nature's  eft'ort  to  get  rid  of  the  irritant.  Xothing 
to  stop  the  movements  should  be  given  until  the 
bowels  have  been  thoroughly  cleared  by  the  treat- 
ment mentioned. 

BAD    HABITS 

What  are  the  most  common  Jjad  habits  of  young 
children  f 

Sucking,  nail-biting,  dirt-eating,  bed-wetting, 
and  masturbation. 

What  do  children  such? 

Most  fre<iuently  the  tlnnnbs  or  fingers,  sometimes 
the  clothing  or  blanket,  often  tlie  '"  ])acitier  "  or  rub- 
ber ni])ple. 

When  is  tJiis  hat>it  most  frequently  seen^ 

it    begins    in    (|uite    early    infancy,    and    if    not 

bi'okcTi    may    hist    until    chihiren    ai'e    six    or    S(>v('n 

years  (i]d. 

Js  the  siirlrniq  luihil  a  Jiarmful  one^ 
When    pcrsi>tc(l    iu    it   may   |»i'<m1uc<'   a    ini-^shapen 
niniitb   <ii'   lingers.      Tt  constantly  stimulatr's   the   th)W 


ISG        THE   CARE   AND    FEEDING   OF   CIIir.DUEN 


of  saliva  and  certainly  aggravates  distnrbancos  of 
iligestion  during  which  the  sucking  habit  is  likely 
to  be  practised.  It  may  lead  to  thrush  or  other  forms 
of  infection  of  the  mouth.  It  is  not  necessary  as  a 
means  of  quieting  a  child,  though  it  may  in  some 
degree  cover  u})  the  consequences  of  bad  feeding  or 
bad  training.  On  no  account  should  the  habit  of 
sucking  the  ''  paciiier  "  be  allowed  as  a  means  of  put- 
ting children  to  sleep,  or  of  quieting  them  while  rest- 
less from  dentition  or  indigestion. 

How  is  the  sucking  habit  to  l>c  controlled? 

One  should  be  sure  in  the  first  place  that  the 
constant  sucking  of  fingers  is  not  d\ie  to  hunger  from 
insufficient  food.  Sucking  of  the  hands  may  often 
be  controlled  by  wearing  mittens  or  fastening  the 
hands  to  the  sides  during  sleep.  In  more  obstinate 
cases  it  may  be  necessary  to  confine  the  elbow  by 
small  pasteboard  splints  to  prevent  the  child  from 
bending  the  arm  so  as  to  get  the  hand  to  the  mouth. 

^Mlen  are  nail-hiting  and  dirt-eating  seen,  and 
how  are  they  to  l)e  controlled? 

Tliese  habits  belong  especially  to  children  over 
three  years  old.  They  are  seen  particularly  in  those 
who  are  excessively  nervous  or  whose  general  health 
is  below  par;  sometimes  in  those  who  develop  serious 
nervous  diseases  later  in  life.      Children  with  such 


I5AD    HABITS  187 


tcndeneie^s  should  be  closely  watched,  and  every 
means  nsed  to  break  up  tliese  habits  early.  Dirt- 
eating-  is  a  njf»rbid  craving  which  is  rarely  seen  in 
a  iK^rnial  child. 

.1/  what  aye  hiaij  a  child  generally  he  expected 
to  (JO  H-ithont  iretfiny  the  bed  diiriny  the  nights 

Usually  at  two  and  a  half  years,  if  it  is  taken  up 
lare  in  the  evening.  Some  children  acquire  control 
of  rhe  bhidder  at  night  when  two  years  old,  and  a 
few  ncit  until  three  years.  After  three  years  habit- 
luil  b('(l-weTTing  is  abnornuil. 

lloii-  sJiotitd  a  yotuiy  cJiild  addicted  to  hed-vet- 
tiny  he  /nanayed .^ 

At  thi'tc  ()r  four  years  of  age,  punishments  are 
smiietiiiK--  u>cful.  especially  when  it  seems  to  de- 
jjciid  Miuvv  updii  the  child's  indifFei-ence  than  any- 
thing ('Ix-.  They  are  of  iio  value  in  ohh'r  children, 
rewai'ds  l)ciiig  much  more  efficacious.  In  all  cases 
one  should  gi\'c  a  cliild  plenty  of  milk  and  wat(U' 
early  in  the  day,  but  no  fluids  after  4  i>.  .\r.,  the  sup- 
per being  always  of  solid  or  semi-solid  food.  'Flu; 
child  .-liould  be  taken  u])  regularly  at  ten  o'clock  or 
thereab(Mit-.  It  often  ha])})ens  that  the  foruuitioii 
or  continuance  of  the  habit  is  due  to  the  child  being 
in  ])Oor  genei-al  condition,  to  -onie  ii'i'itation  in  the 
ui-ine.   rii'   in   the  genital  organs.      I'nless  the   simple 


188        THE   ("ARE   AND    FKEDIXG    OP   CIIILDRKN 


inciins  inenticmocl  are  suceessfiil  the  cliild  should  be 
])laced  under  the  charge  of  a  physician. 

What  is  masturhation? 

It  is  tlie  habit  of  rubbing  the  genital  organs  with 
the  hands,  \vith  the  clothing,  against  the  bed,  or  rub- 
bing the  thighs  together.  Sometimes  the  child  sits 
npon  the  floor,  crosses  its  thighs  tightly  and  rocks 
backward  and  forward.  Many  of  these  things  are 
passed  ov^r  lightly  and  are  regarded  for  months  as 
simply  a  "  queer  trick  "  of  the  child.  It  may  be 
seen  at  any  age,  even  in  those  not  more  than  a  year 
old,  and  in  both  sexes. 

How  should  such  a  child  he  treated? 

Masturbation  is  the  most  injurions  of  all  the  bad 
habits,  and  should  be  broken  np  just  as  early  as  pos- 
sible. Children  should  especially  be  watched  at  the 
time  of  going  to  sleep  and  on  first  waking.  Punish- 
ments and  mechanical  restraint  are  of  little  avail  ex- 
cept with  infants.  With  older  children  they  usually 
make  matters  worse.  Rewards  are  much  more  effi- 
cacious. It  is  of  the  utmost  importance  to  watch  the 
child  closely,  to  keep  his  confidence,  and  by  all  pos- 
sible means  to  teach  self-control. 

Some  local  cause  of  irritation  is  often  present, 
which  can  be  removed.  ]\Iedical  advice  should  at 
once  be  souirht. 


VACCINATION  189 


VACCIXATIOX 

Nowadays  wJien  small-pox  occurs  so  seldom  is  it 
necessary  to  liave  every  cliild  vaccinaled? 

It  should  by  all  means  be  done.  It  is  only  by 
the  practice  of  general  vaccination  that  sniall-pox  is 
kept  down.  In  countries  or  in  communities  where 
vaccination  is  neglected,  frightful  outbreaks  of  sniall- 
})ux  occur  every  now  and  then  just  as  in  olden  times. 

WJiat  is  the  best  time  for  vaccination? 

The  time  usually  selected  is  from  the  third  to  the 
sixth  month.  It  nuiy  be  deferred  in  a  very  delicate 
child  who  is  not  likely  to  be  exposed  to  snudl-pox,  or 
in  a  child  suffering  from  any  form  of  skin  disease. 

Which  is  'preferable  for  vaccination,  the  ana  or 
the  leg? 

Tlie  part  which  can  l)o  most  easily  protected  and 
kept  at  rest  is  to  1x3  chosen.  In  infants  who  do  not 
yet  walk  or  creej),  the  leg  is  to  be  preferred;  in  ohh>r 
childreu,  in  most  circuuistances,  the  aru).  If  older 
chihlren  are  vacciuated  on  the  leg,  they  should  not 
be  allowed  to  walk  much  while  tiie  vaccination  is 
active. 

When  sjiuuld  vaccination  t/e  repeated? 
An   unsuecesst'id   vaecinat  i<iu    ])roves  uothiug  and 
should  \xi  repeater!  in  two  or  three  weeks.     If  success- 


11(0   THE  CARE  AND  FEEDING  OF  CHILDREN 

h\]]y  vaccinated  in  infancy,  a  child  should  invariably 
be  revaccinated  before  ])uberty.  If  ex])osed  or  likely 
to  be  ex])08ed  to  small-])ox  at  any  time  vaccination 
should  be  re])eated. 


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University  of  California 

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305  De  Neve  Drive  -  Parking  Lot  17  •   Box  951388 

LOS  ANGELES,  CALIFORNIA  90095-1388 

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